ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

12 27 20 36ContentsThe ANZCA BulletinThe Australian and New Zealand Collegeof Anaesthetists (ANZCA) is the professionalmedical body in Australia and New Zealandthat conducts education, training andcontinuing professional developmentof anaesthetists, intensive care medicineand pain medicine specialists. ANZCArepresents more than 5000 Fellows andtrainees across Australia and New Zealandand serves the community by ensuringthe highest standards of patient safety.EditorialMedical EditorDr Michelle MulliganEditorNigel HenhamSub-editorLiane ReynoldsStaff writerKate SaundersDesignChristian LangstoneSubmitting letters and materialWe encourage the submission of letters,news and feature stories. We prefer lettersof no more than 500 words and they mustindicate your full name and addressand a daytime telephone number.Advertising inquiriesTo advertise in The ANZCA Bulletin pleasecontact Marc Wilson, ANZCA advertisingsales representative, on 0419 107 143 oremail marc@gypsymedia.com.au. Anadvertising rate card can be found onlineat www.anzca.edu.au/news/bulletinContactsHead office630 St Kilda RoadMelbourne Victoria 3004AustraliaTelephone +61 3 9510 6299Facsimile +61 3 9510 6786nhenham@anzca.edu.auwww.anzca.edu.auJoint Faculty of Intensive Care MedicineTelephone +61 3 9530 2862jficm@anzca.edu.auFaculty of Pain MedicineTelephone +61 3 8517 5337painmed@anzca.edu.auCopyrightCopyright © 2009 by the Australian andNew Zealand College of Anaesthetists,all rights reserved. None of the contentsof this publication may be reproduced,stored in a retrieval system or transmittedin any form, by any means without theprior written permission of the publisher.Cover: Royal Adelaide HospitalPhoto: Joe VittorioASM Cairns WrapSnapshot and overview ofANZCA’s Annual ScientificMeeting in Cairns.2 President’s message3 News4 People and events6 Awards and scholarships8 ANZCA Council Meeting report9 Annual General Meeting minutes12 ASM Cairns Wrap20 The Future of Anaesthesia30 Private practice: improving patient care34 In the field: Dr Gavin Pattullo36 Diving and Hyperbaric Medicine roundtable41 Profile: Dr Vanessa Beavis42 Profile: Dr Tony Richards43 The ANZCA Foundation46 Quality and Safety news50 Successful Candidates 200956 CanMEDS Curriculum Framework59 Continuing Professional Development62 Library update65 Regions70 New Zealand news76 Joint Faculty of Intensive Care Medicine83 Faculty of Pain Medicine94 Obituary95 Professional documents98 Future meetingsThe Futureof AnaesthesiaWhat lies ahead for thespecialty and what rolesshould anaesthetists play?Diving and HyperbaricMedicine roundtableAnaesthetists at Royal HobartHospital discuss an interestingarea of medicine.The ANZCA Bulletin June 2009 1

President’smessageIn this edition of the Bulletin we examinethe future of anaesthesia. This followsthe release in March of the Australianworkforce study “Supply and Demandfor Anaesthesia Services” which lookedinto factors that shape the supply of, anddemand for, anaesthesia services andidentified gaps in service provision over thenext 20 years. A similar survey is plannedfor New Zealand. As I mentioned when thestudy was released, it is vitally importantthat ANZCA take a central role in not onlyassessing the demand for anaestheticservices and the number of anaesthetistsrequired but that we also have a viewabout the proper scope of services and theappropriate model of care. In this editionwe publish some views about the future ofour specialty and we take a look at someinteresting and exciting developmentsin some private practices in Australiawhich will hopefully stimulate debateabout future directions. There are manychallenges in front of us as we continue tofulfil our aim of serving the community byfostering safe and high quality patient carein anaesthesia, intensive care andpain medicine.College of Intensive Care MedicineOur colleagues in the Joint Faculty ofIntensive Care Medicine have decidedthat their specialty is best served byestablishing an independent college,and preparations for this are now wellunderway. I would like to thank Fellowswho took the time to vote on the resolutionto endorse Council’s decision in respect ofseparation issues. In the JFICM vote, 1310votes were counted, 1161 for (88.6%) and149 against (11.4%). ANZCA’s support for anew College has been gratefully receivedby JFICM and it provides a strong basis forexcellent relations in the future.Our training programs and standardsetting processes have been separatefor some time so for many people, theseparation will have very little directeffect. The group who could be affectedwill be our Fellows who practice bothanaesthesia and intensive care medicinebut have FANZCA and not FJFICM. TheseFellows are mainly working in smallerhospitals, and we (ANZCA and CICM) willbe supporting their practice. We anticipateworking very closely with the new Collegeon this and other matters, as we do withother specialist medical Colleges. This iscritical with our current advocacy for theretention of the role of medical collegeswithin specialist medical training andaccreditation. Having multiple colleges isa strength of our system, as each specialtycan develop its own standards in a waythat is best suited to the specialty.ANZCA FoundationA great deal of work has been undertakenin recent months to complete the essentialinfrastructure for the ANZCA Foundation.This has included developing a suite ofpromotional materials, establishing a fundraising database, and consulting withregional committees to seek their input.Raising funds for medical research andraising awareness of anaesthesia, perioperativemedicine and pain medicineresearch and education is crucial. Withongoing research we can improve thequality of outcomes for patient comfortand can return many people to virtuallynormal lives in work, family enjoymentand community activities. The success ofthe Foundation will depend greatly on theparticipation and willingness of Fellowsand trainees to support it, includingcommunicating its existence and benefitsmore widely. To this end, in July you willreceive some information and promotionalmaterial covering the Bequest programand the Patrons Program. By supportingthe Foundation you will be making a vitalcontribution to promoting the role that ourprofession makes to the well-being of somany people and enable further crucialresearch to be undertaken.ANZCA Strategic PlanWork continues on developing a revisedANZCA Strategic Plan for the next threeyears. Our current plan has led to a rangeof important projects and improvements.Consultation continues with regionalcommittees and other key stakeholders.Council will consider the plan further atits August Council meeting. It is envisagedthat the key elements of the strategy will becommunicated to Fellows and trainees inthe months ahead.Dr Leona WilsonPresident2The ANZCA Bulletin June 2009

NewsSafety of AnaesthesiaReportThe Mortality Working Group reviewsanaesthesia-related mortality in Australiaand New Zealand under the auspices ofANZCA. The report for the period 2003-2005will be published next month. This is the fifthtriennial report collated and published byANZCA. The report will be sent to Fellows andtrainees in July and will be disseminated toall appropriate bodies to contribute to furtherimprovements in patient safety.Australian budgetThe Australian Government has announced$A500 million funding to support theexpansion of pre-professional clinicaltraining places by 2013. This fundingwill support clinical training for anexpected increase of 12,000 in healthrelatedundergraduate school numbers– from 66,000 in 2009 to 78,000 in 2013. Anadditional 212 ongoing GP training places willbe provided as well as 73 specialist trainingplaces in the private sector. The governmentalso announced the establishment of theNational Workforce Agency to “bettercoordinate and expand capacity for clinicaltraining across a range of workforce settingsand assist with workforce planning”.MABEL doctors surveyThe first results of the MABEL longitudinalsurvey of doctors have been released.There were 10,512 participants in thesurvey including 4603 specialists and 1072doctors enrolled in a specialist trainingprogram. Initial results showed that over80% of doctors were satisfied with theirwork. Specialists were the most likelyto want to reduce their hours of work.Although satisfaction levels were high,the survey found that 12% of GPs and 13%of specialists were “very likely” to quitmedical work entirely within the next fiveyears, driven largely by people aged over55 who were expected to retire. For furtherinformation visit www.mabel.org.au oremail enquiries@mabel.org.auAustralian nationalregistration andaccreditationscheme updateA Senate inquiry into the FederalGovernment’s proposed nationalregistration and accreditation scheme isdue to report by the end of June, althoughthis is likely to be delayed. Since theSenate inquiry began, the AustralianHealth Workforce Ministerial Councilhas announced a number of changes,including making the accreditation functionindependent of government and remainingwith the Australian Medical Council –something ANZCA has consistently calledfor. There will be both general and specialistregisters for medicine. The specialistregister will not cover practitionersregistered to practice in an area of need.There is also acknowledgement of the roleof specialist medical colleges in the areaof continuing professional development.Part B of the legislation, which outlines theoperation of the scheme, has been releasedprior to its introduction to the QueenslandParliament in the second half of 2009.NZ budget booststrainee numbersThe New Zealand Government hasannounced an additional 60 medicalschool places boosting trainee doctornumbers by 200 within five years and a$NZ15.3 million voluntary bonding schemeto decrease New Zealand’s dependence onforeign-trained doctors. A further $NZ70million has been earmarked to train 800additional anaesthetists, surgeons, residentmedical officers, nurses and techniciansand other health professionals to staff andsupport the new elective surgery “supercentres”. The government has said it iscommitted to building 20 new electivesurgery theatres with associated bedsand facilities as part of its policy toreduce hospital waiting times andincrease access to elective surgery.Launch of ANZCAFinal Examinationpreparation resourceTo assist trainees preparing for the ANZCAFinal Examination, a new resource thatprovides insights into the exam process andwhat happens on the day has been launched.It includes examples of “mock” vivas todemonstrate ways to optimise performanceand can be found on the ANZCA website.The ANZCA FoundationPatrons ProgramThe ANZCA Foundation will shortlyintroduce a Patrons Program to encourageand recognise those who wish to supportmedical research and education. Alldonations (which are tax deductible) willbe directed solely towards medical researchand education with the ANZCA Councildetermining the awarding of the grants.Full details will be made availablein coming months.RASTS program –web conferencing pilotANZCA is piloting web conferencingtechnology that will soon be available toall trainees. The education developmentunit is looking for trainees now on rotationin a rural area who are preparing for theANZCA Final Examination to participatein the pilot. Please contact Susan Batur(+61 3 0093 4909) oremail SBatur@anzca.edu.auBest of web projectANZCA has launched a “best of web”initiative that aims to review existingonline educational material and evaluateit for its applicability to all Fellows andtrainees. Each online resource will bereviewed, rated and approved for claimingcontinuing professional development(CPD) points. The project group is seekingtopic recommendations from Fellows andtrainees. Please send your suggestionsto cpd@anzca.edu.auThe ANZCA Bulletin June 20093

People& EventsFinal FellowshipexaminationNew Fellows’ConferenceThe final oral examination was heldon Thursday, May 29 and Friday, May 30at the Melbourne Convention andExhibition Centre. One hundred and fiftycandidates successfully completed thefinal fellowship examination and threecandidates successfully completed theIMGS Performance Assessment. The resultswere announced at 7pm on both Fridayand Saturday nights at ANZCA Housein Melbourne.For the first time, candidates wereable to receive their results using the SMSResults Service as well as attending theCollege to view the posted results, receivinga paper copy of the results or viewing themon the ANZCA website. Approximately 50examiners were in Melbourne to participateat both the oral examination and thepreceding meetings that were held at theCollege on Thursday, May 28.Above: Dr Wat Chun Yin, Dr Wong Hoi KayTiffany, A/Prof Jacobus Ng (Final FellowshipExaminer), Dr Chan Lai Mel and Dr Chan On Yi;Dr Chris Butler (Final Fellowship Examiner),Dr Elizabeth Egan and Dr Margaret Knight.The 2009 ANZCA New Fellows’ Conference(NFC) was held over three days at thefabulous Thala Beach Resort, just southof Port Douglas and a little less than anhour north of Cairns, where the ANZCAASM took place over the following five days.The NFC offers recent Fellows a few daysaway from work to discuss issues broadlyrelated to professional and College matters.This year the theme of the NFC was“Keeping Doctors Well”. The facilitatorswere Dr Paul Carter, a GP with an interestin psychological medicine; Dr AllanCyna, an anaesthetist with an interestin hypnotherapy; Trish Johnson, apsychologist who spoke about happiness;the 2009 NFC Councillor in Residence,Dr Genevieve Goulding; the FPMrepresentative to the 2009 NFC, Dr BrendanMoore; and the representative from the2008 NFC, Dr Sally Ure. The CollegePresident, Dr Leona Wilson, joined usfor the second evening.The program was eclectic and encouragedgroup participation. The formal sessions,whilst for the most part lecture-based,fostered lively dialogue. The great debatesshowcased oratory ranging from theridiculous to the sublime and back again.Dr Carter also commented that the chickendance at the end of the group hypnotherapysession on the final morning was the besthe’d ever seen.Having attended the 2008 NFC andorganised this year’s, I must say I regardthe NFC’s existence as being a reflection ofa College in robust health. I’m grateful forthe excellent logistic support afforded byCollege staff, especially Kate Briggs. Thespeakers and delegates formed a terrificgroup whose company and ideas I greatlyenjoyed sharing.The 2010 NFC will be held nearChristchurch and will be run by DrKaren Ryan. The theme is “Adventures inAnaesthesia”. Fellows of up to eight years’standing are encouraged to apply.Dr Chris JacksonConvenor, 2009 NFCClockwise from top left: The New FellowsConference delegates and facilitators; DrBrendan Moore, Dr Bruce Hammonds, DrIrina Kurowski, Dr Patricia Kan and Dr DianaWebster; Dr Tim Porter, Dr Allan Cyna, Dr LeonaWilson (ANZCA President), Dr Tomoko Hara,Dr Genevieve Goulding, Dr Shiva Hampasagarand Dr Bruce Hammonds.4The ANZCA Bulletin June 2009

Simulation-based sedationcourse for endoscopistsNine senior New South Wales gastroenterologistsparticipated in a pilotsimulation-based sedation course forendoscopists conducted at the HunterNew England Skills and Simulation Centrein Newcastle from May 22-23, 2009. Thecourse was developed to meet objectivesdelineated by the Tripartite SedationWorking Group by Hunter New EnglandSimulation Director Dr Cate McIntosh andFaculty from the Centre. Also attending theresuscitation simulation sessions on thesecond day were five endoscopsy nursesfrom participating gastroenterologists’hospitals.Professor Barry Baker chairedthe Sedation Working Group, withrepresentation from ANZCA (A/Prof KateLeslie and Drs Jo Sutherland and TraceyTay), the Gastroenterological Society ofAustralia (Drs Brian Jones, Michael Burke,Phillip Craig and Andrew Thomson) andthe Royal Australasian College of Surgeons(Drs Tony Eyers and Jon Gani). The GreaterMetropolitan Clinical Taskforce, NSWHealth, provided funding for the pilotcourse and secretariat support for theTripartite Sedation Working Group (MsCassandra Smith).Participants engaged enthusiastically inthe two-day course which included tutorialson the pharmacology of sedation drugs,problem-based learning discussions onrisk management, and medical assessmentin the context of sedation, skills trainingand immersive simulation scenarios withinthe framework of PS9 2008 Guidelines onSedation and/or Analgesia for Diagnosticand Interventional Medical and SurgicalProcedures. In order to assess the coursepre-and post-testing of the participants’knowledge, skills and attitudes/behavioursrelating to sedation were carried out.Participants displayed great insightand willingness to learn. One participanthighlighted that the course was notabout propofol, but about deliveringsafe sedation.Early written feedback from theparticipants has been praiseworthy:“Congratulations! What a fabulousexperience, it was clear that an enormousamount of time, planning and energy wentinto bringing this course to the humble GEconsumer. It is clear to us that it needs tobe part of the core training curriculum forGE trainees.”A clear message from thegastroenterologists is that simulationoffers great benefits for training in sedationand should be an essential component oftraining for both registrars and experiencedclinicians. An invitation has been extendedto Cate McIntosh to speak about the benefitsof simulation-based training to the widergastroenterology community.Inquiries for places in the nextcourse have already been received. Acomprehensive evaluation of the courseis being conducted and results will bedisseminated. It is planned to extendthis type of course to other states andNew Zealand.While participants have yet to completethe full sedation training process, whichincludes practical clinical sessions intheir hospitals, this pilot Sedation Coursefor Endoscopists represents a significantstep towards improving the safety ofsedation for patients. The participantshave clearly demonstrated an ability toreflect on their current practice with patientsedation and a desire to improve theirknowledge and skills. Equally as importantis the foundation that has been laid for apartnership in quality and safety that willresult in ongoing gains for patients.Dr Tracey TayClockwise from top left: Back row: Judy Tighe,Warwick Selby and Barry Baker; Middle row:Michael Bourke, Joanne Shafer-Benhamu,Grace Chapman, Ian Norton, Philip Craig,Tracey Tay, Charles McDonald, David Abi-Hanna and Jo Sutherland; Front row: BrianJones, Jeanette Valdivia, Kathleen O’Connor,Cameron Bell and Greg O’Sullivan; Teamworkduring the simulation-based sedation course;Cardiac resuscitation during the simulationbasedsedation course.The ANZCA Bulletin June 2009 5

AWARDS and scholarshipsANZCA Undergraduate Prizesin AnaesthesiaThe ANZCA Undergraduate Prizes inAnaesthesia were established to fosterundergraduate and postgraduate teachingof anaesthesia, its related disciplinesand perioperative medicine, and to raiseawareness of the specialty among medicalstudents and recent graduates. Each yearprizes are awarded within Australian andNew Zealand medical schools to final yearmedical students who achieve the bestoverall performance in the anaesthesiamodule of their clinical curriculum.The prize comprises a certificate andbook voucher. 2008 prize winners are:Dr Roger BoothSchool of Medicine,University of TasmaniaDr Lynette McGaughranSchool of Medicine,University of AucklandDr Phillipa RainsFaculty of Medicine,University of SydneyDr Sebastian CorletteSchool of Medicine,Flinders UniversityDr Mei Ling PearsonChristchurch School of Medicineand Health Sciences,University of OtagoDr Belinda JacksonFaculty of Medicine, Nursing andHealth Sciences, Monash UniversityGilbert Troup PrizeDr Tim Mitchell received the2008 ANZCA/ASA Gilbert TroupPrize within the School of Medicineand Pharmacology, Universityof Western Australia.AnzcaTrainingScholarshipsfor 2010ANZCA will make available 20 scholarships each year to assistanaesthesia trainees experiencing severe financial hardship.Each scholarship will be awarded in the form of a 50% reductionin the annual training fee for the following year. Applicants mustbe registered trainees of ANZCA.Applications must be submitted on the prescribed2010 ANZCA Training Scholarship Application Form,copies of which are available from the College.Please contact: Hannah BurnellAustralian and New Zealand College of Anaesthetists630 St Kilda Road, Melbourne Vic 3004Ph: +61 3 8517 5392Email: hburnell@anzca.edu.auThe closing date for applications for 2010 is Friday, August 7, 2009.Successful applicants will be notified in October 2009.ANZCA InternationalScholarship for 2010The Australian and New Zealand College of Anaesthetistsinvites suitable applicants for the ANZCA InternationalScholarship for 2010.This prestigious award is for anaesthetists of the highest quality whoare destined to be leaders in their home countries. The scholarshipis offered to a young anaesthetist (aged up to 40) from Papua NewGuinea, Fiji or the South Pacific Islands. Applications from Myanmar,Vietnam, Laos or Cambodia will also be considered. It is intendedto provide an opportunity for the anaesthetist to develop skills tomanage a department and to become competent in teaching in theirhome country. The scholarship is tenable generally for one yearin a department of a major hospital in Australia or New Zealand.It covers travel expenses between the home country and Australiaor New Zealand and may also include travel expenses for thescholar’s spouse and children aged under 16. A living allowancewill be provided. The closing date for this Scholarship is Friday,August 7, 2009. No late applications will be considered.For additional information and a copy of the application form,please contact:Janelle TaltyAustralian and New Zealand College of Anaesthetists630 St Kilda Road, Melbourne Vic 3004Ph: +61 3 9093 4913Email: jtalty@anzca.edu.au6The ANZCA Bulletin June 2009

anzca Research AwardThe Lennard Travers ProfessorshipA Lennard Travers Professorship willbe awarded for the year 2011.Under the terms of its foundation, applications for this Professorshipare invited from Fellows of the College desiring to pursue researchor a course of study (part-time or full-time) in anaesthesia or relateddisciplines in Australia, New Zealand, Hong Kong, Malaysiaor Singapore.The award of the Professorship carries an emolument of $30,000 whichshould be considered as a “grant in aid” and does not preclude theacceptance of grants from other sources.The successful applicant will be required to commence the researchby May 2011 and to deliver the Australasian Visitor’s Lecture at theAnnual Scientific Meeting of the College in 2012. Travel expenseswithin Australasia for this latter commitment are not included in theaward and will be a separate responsibility of the College.Applications must be submitted on the Application Form, which detailsthe nominated area of work and the way in which the study will be carriedout, and be accompanied by a full curriculum vitae and the names ofthree referees to whom reference may be made. The Application Formwill be available on the ANZCA website from 1 December 2009.Applications should be forwarded, by 1 April 2010, to:The Chief Executive OfficerAustralian and New Zealand College of Anaesthetists630 St Kilda RoadMelbourne Vic 3004Email: ceoanzca@anzca.edu.auFor further information or to obtain an Application Form,please contact:Jill HumphreysExecutive Officer, IMGS AccreditationTel: 03 8517 5336Email: jhumphreys@anzca.edu.auThe Dr Ray Hader TraineeAward for CompassionDetails of the AwardEligibility: At the deadline for submissions, the nominee will bean Accredited ANZCA Trainee resident in any ANZCA Training Regionor an ANZCA Fellow within three year of admission to Fellowshipby Examination.The nominee will have made a significant contribution to the welfareof an individual, a group or a system that promotes welfare andcompassion. The individual, group or system will be preferentiallyrelated to anaesthesia, but may alternatively or also be related toother colleagues, patients or the community (locally or internationally).Nominations are sought from ANZCA Trainees and Fellowswithin three years of Fellowship by Examination for theDr Ray Hader Trainee Award for Compassion. The deadlinefor nominations is October 2, 2009.Dr Ray Hader was an ANZCA Trainee who grew up and lived in Victoria.He died in 1997 of an accidental drug overdose after a long strugglewith drug addiction. To mark the 10-year anniversary of his death,a friend, Dr Brandon Carp, established an award that promotesa compassionate approach to the welfare of anaesthetists, othercolleagues, patients and the community.Nomination: Nominees will be nominated and seconded by AccreditedANZCA Trainees resident in any ANZCA Training Region or ANZCAFellows within three years of admission to Fellowship by Examination.The nominator will describe in 1000 words or less how the candidatehas made a significant contribution. The description will be accompaniedby a covering letter signed by the nominator and seconder.Deadline: Nominations must be received by the CEO by 5pmOctober 2, 2009.Prize: A$2,000 to be used for Training or Educational purposesand a certificate.The ANZCA Bulletin June 2009 7

ANZCA CouncilMeeting reportReport following the Council Meetingof the Australian and New ZealandCollege of Anaesthetistsheld on April 18, 2009Death of FellowsCouncil noted with regret the death of thefollowing Fellows:Dr Sydney Dennis Giddy (Vic), OAM -FFARACS 1968, FANZCA 1992Dr Rodney Hickey (NZ) – FFARACS 1974,FANZCA 1992Honours and AwardsA/Prof Stephen Gatt (NSW) has beenelected to Fellowship of the Royal Collegeof Anaesthetists.Education and Training CommitteeAssessmentsIt has been agreed that new examinerswill undergo a probationary appointmentperiod of 12 months for the PrimaryExamination and 18 months for theFinal Examination.Advice to poorly performing candidatesA process has been adopted for bothPrimary and Final examination candidatesand is available from the Training andAssessments Department.Educational innovation fundingThe Educational Innovation Grants havebeen renamed to reflect that they are notresearch grants, but tenders. The priorityareas for the 2010 funding have beenidentified as follows:• Workplace-based assessment ofanaesthesia trainees• Clinical teacher support and developmentInternational Medical GraduateSpecialists CommitteeIMGS assessment process – workplacebased assessmentsSubsequent to approval of the IMGSassessment process and the supportingdocument titled Workplace BasedAssessments Process for IMGS in February,it has been suggested that Council shoulddefer the WBA for partially comparableIMGS to a date to be determined pendingfurther discussion. Regulation 23 has beenamended to reflect this decision.Fellowship Affairs CommitteeAnnual Scientific Meeting – 2012 PerthDrs Tanya Farrell and David Vyse havebeen appointed co-convenors for the 2012ASM to be held in Perth.Internal AffairsCommunity representativesto College committeesThe arrangements for communityrepresentatives are under review, andwill include time-limited appointmentsand review of remuneration in line withthe Australian Government TribunalGuidelines. New sources for communityrepresentatives are to be investigated toexpand the pool of available personnel.Regulation 2.7.1 - Education andTraining CommitteeThis Regulation was amended to includethe following as ex-officio members:chairs of the Primary Examination, FinalExamination, Assessments and WorkplaceBased Assessments subcommittees.ANZCA support for developing countriesAn ad hoc working party has beenestablished to review the provisionof assistance to developing countries,particularly in South East Asia.The working party comprises:A/Prof Kate Leslie (Chair)Dr Michael CooperDr Wayne MorrissDr Richard MorrisProf Garry PhillipsDr Peter CookRelationship between ANZCA, Fellows,trainees and the healthcare industryA working group has been established todevelop a consultation paper outliningrelevant generic issues on the relationshipsbetween the healthcare industry and Fellowsand Trainees. The working group comprises:Dr Lindy Roberts (Chair)Dr Michelle MulliganDr Richard WaldronProf Alan MerryDr Rowan ThomasDr Kim GrayA representative of the ANZCATrainee CommitteeRelevant members of staffFellows and Trainees will be given theopportunity to respond to issues raised inthe consultation paper before a series ofrecommendations is made to Council laterin 2009.Strategic WorkshopThe August 15, Council Meeting will becondensed to provide a half day dedicatedto strategic planning.ProfessionalProfessional documentsPS51 – Guidelines for the SafeAdministration of Injectable Drugsin Anaesthesia has been promulgatedand is available for downloading fromthe College website.A new document titled “Process forreview of College ProfessionalDocuments” has been approved and isavailable for downloading from the Collegewebsite.ANZCA Representatives to externalorganisationsProf Guy Ludbrook has been nominatedas the ANZCA Representative to theAustralian Drug Evaluation Committee.Following a recommendation from theObstetric Anaesthesia SIG, Dr AliciaDennis has been confirmed as the College’srepresentative to the steering committeefor the Core Competencies and EducationalFramework for Maternity Services inAustralia Project.ResearchANZCA FoundationCouncil supported the request from theFoundation to raise funds in support ofthe publication of the hard copy of AcutePain Management: Scientific Evidence ThirdEdition 2010.New Programs CommitteeCertificate in Diving and HyperbaricMedicine – Post NominalIt has been agreed that the post nominalfor certificate holders in Diving andHyperbaric Medicine will be “Cert DHM(ANZCA)”. This may only be used bypractitioners who are up-to-date with theirannual certification fee.Dr Leona WilsonPresidentA/Prof Kate LeslieVice-President8The ANZCA Bulletin June 2009

Annual General MeetingminutesMinutes recording the proceedings of the Annual GeneralMeeting of the Australian and New Zealand College ofAnaesthetists held in Hall B at the Cairns Convention Centreon Tuesday, 5th May 2009 at 5pm.Present Dr Leona Wilson (President and Chair) and thefollowing Fellows who indicated their attendance on thecirculated register:Dr Bruce Adendorff, ACTProf Barry Baker, NSWDr Jane Baker, NSWDr Phil Byth, NSWDr Peter Cook, QLDDr Martin Culwick, QLDDr Robert Edeson, WAMr Michael Gorton, VICDr Genevieve Goulding, QLDDr Kerry Gunn, NZDr Steuart Henderson, NZDr Kevin Johnston, QLDDr David Jones, NZDr Ross Kerridge, NSWDr Nathan Kershaw, NZA/Prof Kate Leslie, VICDr Martin Lum, VICDr Ruth Matters, TASDr David McConnel , QLDDr Jane McDonald, NSWProf Alan Merry, NZDr Frank Moloney, NSWDr Michelle Mulligan, NSWProf Paul Myles, VICDr Timo Nyman, SADr John O’Reilly, QLDDr Greg O’Sullivan, NSWHon. Brian Pezzutti, NSWDr Nicole Phillips, NSWDr Mark Priestley, NSWDr Ian Rechtman, VICDr Richard Riley, WADr Lindy Roberts, WAProf John Russell, SADr James Sartian, QLDDr Joe Sherriff, NZDr Richard Simmie, VICDr Natalie Smith, NSWDr Renhard Steiner, SADr Joanne Sutherland, NSWDr Sandra Taylor, NSWDr Annette Turley, QLDDr Richard Waldron, TASDr Margaret Walker, TASDr Andrew Warmington, NZDr Robert Webb, QLDDr Richard Willis, SAIn Attendance Dr Mike Richards (CEO) 3Ms Carolyn Handley (Director, Corporate)Ms Jess McKay (Director, Finance and Business Administration)The President welcomed all in attendance to the sixteenthAnnual General Meeting of the Australian and New ZealandCollege of Anaesthetists.ApologiesApologies for non-attendance were received from:Dr Kerry Brandis, QldDr Penelope Briscoe, SADr Vernon Cook, NZDr Peter Duff, QldDr Elizabeth Feeney, NSWA/Prof Stephen Gatt, NSWDr Basil Hutchinson, NZDr Gordon Kellerman, QldA/Prof Greg Knoblanche, NSWDr John Lauritz, QldDr Bernard Lee, WADr David McCuaig, VicDr Desmond McQuillan, NZDr George Merridew, TasDr Taryn Naggs, QldDr Edmond O’Loughlin, WADr Harry Oxer, WADr John Paull, TasA/Prof David Scott, VicProf Hugo Van Aken, GerDr Paul Wajon, NSWDr Brent Waldron, NZDr Rod Westhorpe, VicDr Michael Whitehead, VicDr John Williamson, SAThe ANZCA Bulletin June 2009 9

Annual General MeetingminutesContinued1. Confirmation of previous meeting held on May 6, 2008The President advised that the minutes of the last meetingheld on May 6, 2008 had been previously circulated, andthere being no amendment, moved that they be accepted.ResolutionFrom the ChairThat the minutes of the Annual General Meeting held onMay 6, 2008 be accepted.Carried2. Report of the CouncilThe President highlighted the following items:• A number of outstanding CME activities took place during2008, with the Annual Scientific Meeting in Sydney ahighly successful and well-received event.• The introduction of the e-newsletter and revamp of theBulletin have helped improve communication with Fellowsand Trainees.• Support for research continued in 2008 through ongoinginput to the ANZCA Foundation.• There was ongoing support for Fellows involvedin training, including increased involvement withgovernment in core areas of training and standard setting.• There has been an increase in the number of Traineesregistering with the College, and the largest examinationsin the College’s history were held during 2008.• The review of the FANZCA curriculum was commenced in2008, and input has been sought from a variety of sourcesas part of this process.• The separation from ANZCA of the Joint Faculty ofIntensive Care Medicine, and the establishment of a newCollege has been negotiated in an atmosphere of mutualrespect. ANZCA was happy to support JFICM’s view thatthe specialty of Intensive Care Medicine would be bestserved through an independent College. As many of theprocesses are separate for most Fellows and Trainees, itwas anticipated that there would be minimum impact asa result of the final separation. The College has undertakento work with the new College to try to ensure that noFellows or Trainees are adversely affected.In concluding her report, the President acknowledged theextensive pro bono work undertaken by Fellows as membersof a variety of committees, supervisors of training, regionaleducation officers, module supervisors, tutors, mentors,examiners and Councillors. She also thanked Collegesolicitor, Mr Michael Gorton, and the CEO, Dr Mike Richardsand the staff for their extensive contributions to the College.There were no questions for the President.3. Annual Financial Reports and Auditor’s ReportThe Honorary Treasurer was invited to present his firstreport on the College’s financial affairs. He highlighted thatthe College maintains its sound financial position with nooutstanding loans or debts. He reported an operating deficitof approximately $500,000 for 2008, which was a significantimprovement on the 2007 deficit of close to $2 million. Themore favourable result for 2008 related to a number ofcost-reduction measures put in place by management.A significant loss for 2008 was reported as a result of adecrease of 30% in the investment portfolio since June ofthat year. It was explained that this has been partially offsetby an 8.3% investment return to date. It was highlighted thatin recent years, the College relied on the investment portfolioto offset any losses incurred in operations. The investmentportfolio encompasses the ANZCA Foundation and representsa source of funding for a variety of scholarships andprofessorships offered by the College, and in addition,provides a capital reserve.The Treasurer reported that in December 2008, Councilresolved that the 2009 management plan would beimplemented in such a way that normal operations wouldno longer be reliant on income from the investment portfolioto balance the overall budget.The College holds net assets of $18 million. Financial checksand balances were completed for 2008 and it was confirmedthat the College has fully complied with the external auditors’recommendations. In addition to this, an internal auditorhas been appointed for 2009.In reiterating the sound financial position of the College, theTreasurer highlighted that this has resulted from the ongoingcommitment of Councillors, committee members, staff andFellows throughout Australia, New Zealand, Hong Kong andSouth East Asia.There were no questions for the Treasurer.The President moved that the balance sheet, income andexpenditure account and auditor’s report for the period endedDecember 31, 2008 be received and adopted.ResolutionFrom the ChairThat the balance sheet, income and expenditure accountand auditor’s report for the period ended December 31,2008 be received and adopted.Carried10The ANZCA Bulletin June 2009

4. Declaration of the PollsCouncil BallotIt was noted that there had been six nominations for thefour vacancies on the Council. In addition to her re-election,the President congratulated Dr Michelle Mulligan on herelection, and standing Councillors Dr Frank Moloney andDr Richard Waldron on their re-election to Council for theperiod 2009 - 2012.The following is the result of the Council ballot:Position on BallotVotes Counted1 WILSON, Leona Fay 8142 MOLONEY, Francis Xavier 7843 WALDRON, Richard John 7314 MULLIGAN, Michelle Janice 6965 FARRELL, Patrick Thomas 6076 BRAZENOR, Stephen Thomas 436Total Votes Counted 40685. Appointment of an auditorThe Treasurer moved, seconded by K Leslie that RSM BirdCameron & Partners be appointed the auditors for the College.There being no further discussion the President put themotion which was carried.ResolutionR J Waldron/K LeslieThat RSM Bird Cameron & Partners be appointed the auditorsfor the College.Carried6. Other business of which due notice has been given to theCEO in accordance with the constitution of the CollegeNo item had been received by the CEO.The President thanked everyone for their attendance,and declared the meeting closed at 5.20pm.Total Ballots Counted 1017Total Votes Counted ÷ 4Envelopes Received 1039Less Invalid Envelopes 20Ballots Received 1019Less Invalid Ballots 2Total Ballots Counted 1017JFICM Separation BallotThe following is the result of the postal ballot regardingthe resolution to endorse Council’s decision in respect ofseparation issues between JFICM and ANZCA:Ballots CountedFor 1161Against 149Total Votes Counted 1310Envelopes Received 1334Less Invalid Envelopes 19Ballots Received 1315Less Invalid Ballots 5Total Ballots Counted 1310The President moved that the Declaration of the Polls bereceived, and put the motion which was carried.ResolutionThat the Declaration of the Polls be received.CarriedFrom the ChairThe ANZCA Bulletin June 2009 11

ASM Cairns WrapThe Australian and New Zealand College of Anaesthetists Annual ScientificMeeting is the principal continuing medical education conference aimedat anaesthetists, pain physicians and intensive care specialists in Australasia.This year the event was held at the Cairns Convention Centre fromMay 2-6. The theme of the meeting was “Anaesthesia: Branching Out.”The regional organising committee worked tirelessly to produce a diversescientific program accompanied by a spectacular social program.12The ANZCA Bulletin June 2009

Snapshot1657 Full registrants 152 Faculty registrants46 Exhibitor registrants 61 Day registrants48 Problem Based Learning 66 WorkshopsDiscussions and QualityAssurance Sessions2009 Prize Winners:Gilbert Brown PrizeDr David Belavy‘Ultrasound guided transversus abdominisplane (TAP) block for analgesia aftercaesarean surgery’Formal Project PrizeDr Angela Palumbo‘Controversies in Anaesthesia Safety:Implications for the Teaching andAssessment of Trainees’“We were delighted (and relieved!)with the overwhelmingly positiveresponse to the scientific program.Many people commented on itsrelevance to practice, as well asthe quality of speakers, bothwell-established and new. Key ideasin the ‘Branching Out’ theme werethe responsibility of anaesthetistsin organ protection, our potentialextended roles in perioperativecare, as well as improving skills andconcepts to enable this to happen.While the brainstorming of ideaswithin our department in Cairns wasfundamental in the formation of theprogram, when one considers the132 invited speaker talks, 114 smallgroup sessions, and 77 free papers orabstracts, the enormous contributionof the wider anaesthetic communityto the success of the meeting isclearly apparent.”Dr James SartainScientific Convenor ASM 2009Regional OrganisingCommittee:Dr Sean McManus – Convenor& health care industry liaison officerDr Rob Grace – Deputy convenor& workshop/PBLD convenorDr James Sartain – Scientificprogram convenorDr Jason Ray – FPM convenorDr Rhonda Boyle – TreasurerDr Emile Kurukchi – WorkshopsDr Catherine Hellier – Socialprogram convenorDr Chris Jackson – New Fellows’conference convenorDr Genevieve Goulding– ANZCA councillorDr Richard Waldron – ASM officer2009 Named Lectures:Ellis Gillespie LectureDr Andrew Lumb from the UK(ANZCA ASM visitor)Challenging dogma in medical scienceMichael Cousins LectureProfessor Andrew Rice from the UK(FPM ASM visitor)Cannabinoid analgesia: Future friendor dead end?Mary Burnell LectureAssociate Professor Dan Raemerfrom the USA (ANZCA QLD visitor)The anaesthetist’s response tovery challenging casesQLD Pain Medicine Visitor’s LectureAssociate Professor Steven Passik fromthe USA (FPM QLD visitor)Risk management in opioid therapyAustralasian Visitors LectureProfessor Matthew Chan from Hong Kong(Australasian visitor)Brain protection in the 21st centuryThe ASM Committee LectureProfessor Tong J Gan from the USA(Special Guest) PONV and ambulatoryanaesthesia: State of the artThe ANZCA Bulletin June 2009 13

From left: Health care industry tradeshow; Dr LeonaWilson, ANZCA President; Cocktail Receptionat The Sebel Cairns; Performer, Lisa Hunt at theCollege Gala Event at Fogarty Park; A session duringthe Scientific Program; The College Gala Event atFogarty Park; Dr David Belavy; Dinner at the CollegeGala Event at Fogarty Park; Prof Michael Cousins& Prof Stephan Schug; The College Ceremony;Prof Maree Smith & Dr Bronwyn Williams;ANZCA Annual General Meeting; Dr Amanda Smith,Dr Sarah Earnshaw, Dr Naomi Pearson, Dr JarrodNgan & Dr Tania Dutton (all from QLD Health);Dr Frank & Cate Moloney, Dr Dick Willis, Dr JennyCarden, A/Prof Kate Leslie & Gretta Willis.14The ANZCA Bulletin June 2009

The ANZCA Bulletin June 2009 15

From left: Dr Vanessa Andean (Austin Hospital),Dr Gordon Wong (Hong Kong University) & Dr LizMackson (St George Hospital); Prof Michael Cousinsis awarded the Robert Orton Medal at the CollegeCeremony by Dr Leona Wilson (ANZCA President);Dr Penelope Briscoe (Dean, FPM) presents Dr CharlesKim with the Barbara Walker Prize for Excellence inthe Pain Medicine Examination; Dr Jason Ray, FPMConvenor; Dr Debbie Bettenay (Northern HospitalMelbourne) & Dr Hannah Parker (Austin Hospital);16The ANZCA Bulletin June 2009

The College Ceremony; Dr James Sartain (ScientificProgram Convenor) & Prof T J Gan (Special Guest); DrPeter Lane, Dr Alex Douglas (both from Royal BrisbaneWomens Hospital) & Dr Wal Grimmett (DownsAnaesthetic Practice); Karen Bryant (C.R Kennedy) &Penny McDougall (Canterbury Anaesthetics ServicesMelbourne); Dr Rae Duffy, Dr Nan Crimmins & DrPeta Lorraway (all from Brisbane); Dr Diana Webster(Redcliff – Caboolture Hospital), Dr Tomoko Hara(Auckland District Health) & Nick Stevens;Dr Geoff Crawford (QLD Health / Logan Hospital)Dr Anthony Sorensen & Dr Maree Meier (GABAAnaesthetics); Dr Miriam Scully, Dr Sue Anastasios,Dr Kim Rees & Dr Gail Aughterson; Dr Vanessa Beavis(Auckland) & Dr Sandy Garden (Wellington Hospital;Dr Sean McManus, Convenor & Health Care IndustryLiaison Officer; Dr Gopi Raju (Royal Brisbane Hospital),S. Balan (Malaysia) & Dr Jahizah Hassan (Penang, Malaysia);Dr Forbes McGain; Dr Lisa Mohanlal, Dr Hamish Holland,Dr Nicole Fairweather & Dr Rod Van Twest; Prof Alan Merry;Health care industry tradeshow; Dr Atlas Ko, Dr Lisa Ku(both from Austin Health) & Dr Michelle Chia (St VincentsHospital); Cairns Convention Centre; Dr Jason Thomas,Dr Brett McGuirk, Dr Andrew Middleton & Dr Simon Jones(all from St Vincents Hospital); Dr Erna Meyer (WhangareiHospital), Dr Annette Turley (Rockhampton Hospital) &Dr Morne Terblanche (Bundaberg Hospital); Dr Kate Fry(Mater Childrens Hospital), Dr Nicola Acworth & Dr JaneMorris (both from Brisbane); Dr Andrew Winter (NarkosPartners), Dr Tony Bergin (Narkos Partners) & Dr KristianLundqvist (Greenslopes).The ANZCA Bulletin June 2009 17

A delegate’s perspectiveFrom the pain management specialist point-of-viewthe ANZCA ASM actually started with the Faculty ofPain Medicine refresher course day. This was wellattended and this year encompassed a variety of topicsby an excellent range of speakers. To cap it off wehad the annual faculty dinner and enjoyed Dr JamieSeymour discussing his personal experiences of havingthe Irukandji syndrome so many times that he almostdid an RCT on himself.The conference proper started with the welcome reception I missed– always painful having to make choices about what to attend. This,of course, was an issue repeated throughout the meeting. Saturdaystarted with the plenary session in which Dr Andrew Lumb gave aconvincing and thought provoking dissertation on dogma. ApparentlyLaplaces law is irrelevant to the alveoli but you still have to say it in theexam and the examiner still has to pass you.Also, there is no evidence to say you are wrong to put epiduralsin asleep or give a muscle relaxant when you can’t mask ventilate.Professor Andrew Rice spoke about Cannabinoids which as a paindoctor I enjoyed – the bottom line being they aren’t much use at themoment. I attended an excellent simulation workshop at Cairns BaseHospital run by Kersi Taraporewella and team. This quality assuranceactivity aligned well with the thrust of the meeting which was thecontrast between perceptions of how we practice and reality. A lot ofmisconceptions were broken down. The simulation theme continuedon Sunday with Professor Dan Raemer’s lecture. The Queensland FPMvisitor, Steve Passik gave an entertaining talk on managing risk in opioidtherapy, again another reality check for some. Hydrophyllic opioidstend to get lost down the toilet easily apparently.The rest of the meeting proceeded in a similar high-quality fashionwith excellent attendances at all the sessions I went to. The difficultairway session on Monday and listening to Steve Bolsin’s experienceson Tuesday afternoon were highlights. A conference in Cairns wouldn’tbe complete without a debate about LMA’s involving Joe Brimacombeand there was excellent insight into the increasing clinical and researchexperience with ultrasound guided blocks. A great deal of interestingresearch was presented including the FPM free papers, the Dean’s prizesession, the Gilbert Brown prize and the ANZCA trials group sessions.The College ceremony and the Gala Event were highlights amongstvery enjoyable social events.The industry turned up in force as usual and I found this a greatopportunity to check out new equipment and catch up with oldcontacts. I am sure most anaesthetists came away with insights notonly into how they can improve their practice but also into theamount of research and administrative activities their colleagues areinvolved in.Dr Charles BrookerDirectorChronic and Cancer Pain ProgramPain ClinicRoyal North Shore HospitalSydneyFrom left: Dr Leona Wilson (ANZCA President) andProf Matthew Chan (Australasian Visitor); CocktailReception at The Sebel Cairns; Cairns ConventionCentre; A/Prof Dan Raemer, ANZCA QLD Visitor;Dr Andrew Warmington (NZSA President) and DrElizabeth Feeney (ASA President); Dr Leona Wilson(ANZCA President) presents Dr Angela Palumbo withthe Formal Project Prize; Dr Leona Wilson (ANZCAPresident) presents Dr David Belavy with the GilbertBrown Prize.18The ANZCA Bulletin June 2009

ASM photo galleries and videosof the plenary sessions are availableonline at www.anzca.edu.auBehind the scenesStanding at the back ofthe Gala Event watchingLisa Hunt light up thecrowd of 1200, I thought tomyself: “I can’t believe weactually pulled this off.”At the 2006 ASM it was suggested theQueensland meeting in 2009 should beheld in Cairns “We would rather comeup to Cairns for a break than have it inBrisbane again.”This made a lot of sense to me as Cairns isan internationally known conference and holiday destination.The Cairns Convention Centre is consistently rated in the top fivein the world. I believed we could make it a memorable experiencefor delegates’ families as well.The early planning was sketchy; none of the committee members hadmuch experience with conference organisation. Then on a flight fromCairns to Brisbane, I drew an iconic image (above). My thinking wasunless we find areas of interest we can only enjoy the fruits ofour specialist qualifications for so long before stagnation occurs.“Branching Out” is vital for professional development and satisfaction.In the next two years we followed the ASM Handbook; choosingthe professional conference organisers (ICMS Australia) nominatingoverseas speakers to invite and planning our program.In September 2008 we had our first full site visit and round-table ROCmeeting. We soon realised we were way behind where we needed tobe. James Sartain became the scientific convenor and Robert Gracethe deputy convenor/small group learning convenor.November was frantic. Personal contacts and the telephone succeededwhere emails had not. We reached out to Australia, New Zealand,Hong Kong, SE Asia, Europe and North America. Our meeting wasbeginning to come together.A tight-knit triumvirate – Rob, James and I – worked furiously,bouncing ideas around every spare minute of the day - what topicswould interest us? Ideas were modified or rejected immediately withlittle concern for niceties.We discovered that conducting an ASM outside a capital citydid pose logistical challenges; beds for US workshops, simulatormannequins, bikes for hire, wet weather contingency for the GalaEvent and many others. The health care industry showed tremendousfaith in our meeting, for which we are grateful.When it came to abstract submissions we learnt that polite emaildeadlines worked for the minority. The majority needed diplomaticprodding from James. Reviewing the free paper submissions wasexhausting, informative and rewarding – the range of quality was wide.The final months were a blur; I slept very little. We argued the issuespassionately and made decisions. Rob Grace was the marketing guruwith phone calls, hand-written faxes and personalised emails senteverywhere anaesthesia occurs, including Africa, Asia, Europe andNorth America. The web page launch and the start of registrationsallowed us to believe the meeting was actually going to happen.All we could do then was hope enough people would come andthat the weather would be kind. They did and it was.Dr Sean McManusConvenorThe ANZCA Bulletin June 2009 19

In the March 2009 edition of theBulletin the findings of a jointANZCA/ASA independent workforcestudy which examined the likelyfuture demand and supply forAustralian anaesthesia servicesraised a number of interestingissues about the possible futureworkforce requirements in Australia.But what is the future of anaesthesia?What lies ahead for the specialtyas a vital component of modernmedicine? What role shouldanaesthetists play in perioperativemedicine? What sort of medicalexpertise and skills will be neededin Australia and New Zealand’shealth care systems? In part oneof a two part series, Australian andNew Zealand anaesthetists andpain medicine specialists providetheir perspective.The Futureof Anaesthesia20The ANZCA Bulletin June 2009

Leading the debate onthe future of anaesthesia:the College’s roleDr Leona WilsonIt is timely to consider where the specialtyof anaesthesia is heading and how theCollege can provide leadership or support.Recent events, such as the formation ofthe College of Intensive Care Medicineof Australia and New Zealand and thehealthcare reforms being contemplatedin both Australia and New Zealand havehighlighted these questions for us.What is anaesthesia? Does it start whenthe patient is attached to the monitorsin theatre and end with extubation? Ifwe consider the mortality reports andresearch on outcomes from anaesthesia,there is a significant contribution tooutcome from pre-operative assessmentand preparation, and post-operativemanagement, as outlined by Alan Merryin this feature. Our patients expect morethan “simple” technical expertise fromtheir anaesthetists. They expect to be ableto make a fully informed choice abouttheir treatment after being providedwith the necessary information in a waythat supports their sense of their ownautonomy. They expect to have a goodoutcome despite suffering significantillnesses. At the same time, those whofund healthcare are trying to contain costs,and one way is bringing our patients in tohospital “just in time” for their procedures.Garry Phillips outlines some of thegovernment expectations of changesin healthcare delivery.If we are to fulfil our commitment tothe provision of safe and high qualityanaesthesia, then we need to incorporatethese aspects within our care, andanaesthesia become peri-operativemedicine. If we don’t, then in my opinionwe run the risk of being sidelined. VanessaBeavis has advocated for anaesthetiststaking a full role in the peri-operativeprocess. I know that peri-operativemedicine is concerning to some becauseof the changes in work practices that mayensue, especially for those in privatepractice, and during the post-operativephase of peri-operative medicine. Inthis edition of the Bulletin there arefour different examples of how thepre-anaesthesia phase is managedexcellently in private practice anda description of an anaesthetist-ledperioperative care unit by Paul Myles.Michael Cousins has outlined theimportant role of pain medicine, especiallythat of the acute pain teams, in perioperativemedicine. The College hassupported research into how peri-operativemedicine would work and await the results.It is important that we do this researchbecause if we don’t, others will and willmake statements about anaesthesia thatdisplay a lack of understanding of ourspecialty. However, the final outcomeof this challenge (is anaesthesia perioperativemedicine?) will be determinedas much by how anaesthetists shape theirwork in the workplace as by the decisionsthat our College makes. I would like toacknowledge the excellent work of Su-JenYap in leading the Peri-Operative Medicinetaskforce, which developed into thePeri-Operative Medicine Committeeof the College.And so, what is the College’s role indetermining the future of anaesthesia?The College was founded in 1952 toserve the community by fostering safe andhigh-quality patient care in anaesthesia,intensive care and pain medicine, withthe main areas of focus being education,standard setting and support for research.This should be our starting point inconsidering the future of anaesthesia.How do we go about meeting that aim? Theconstitution outlines in more detail theobjects of the College; these include:• promote and encourage the study,research and advancement of the scienceand practice of anaesthesia, intensivecare medicine and pain medicine;• promote excellence in healthcareservices and cultivate and encouragehigh principles of practice, ethics andprofessional integrity in relation tomedical practice, education, assessment,training and research;• determine and maintain professionalstandards for the practice of anaesthesia,intensive care medicine and painmedicine in Australia and New Zealand;But first, we need to consider how anew model of care is developed. Whoserole is it? The College’s, the hospitalDepartments of Anaesthesia, theindividual anaesthetist’s, the institutionsin which anaesthetists work, governmentsor other stakeholders’? Or is it all of them,interacting in a fluid manner? How do wemake sure we take advantage of new andinnovative ideas from “outside the loop”?Once such models of care are developed,the College’s role in supporting researchinto the safety and quality of such careis obvious, and such work is alreadyunderway. For instance, a grant has beengiven in support of the REASON (researchinto elderly patient anaesthesia andsurgery outcome numbers) study.The College’s role of standard setting is acore function: there are standards alreadydeveloped in the pre-operative setting andthe post-operative phase, and as the modelof care changes, then these will need tobe amended, and others developed asneeded. Education, both of trainees andspecialists is the third core function, andperi-operative medicine is an essential partof both the pre-Fellowship curriculum andassessment, and continuing professionaldevelopment program.The increasing focus on perioperativemedicine as part of the futureof anaesthesia is an exciting directionfor anaesthesia, and the College willbe providing support for research,development of standards of practice,and education of trainees andcontinuing education of specialistsin peri-operative medicine.Dr Leona WilsonANZCA PresidentReferences:PS7: Recommendations on The Pre-AnaesthesiaConsultation Guidelines on Consent forAnaesthesia or SedationPS3: Guidelines for the Managementof Major Regional AnalgesiaPS4: Recommendations for the Post-AnaesthesiaRecovery RoomPS15: Recommendations for the PerioperativeCare of Patients Selected for Day CareSurgeryPS41: Guidelines on Acute Pain ManagementThe ANZCA Bulletin June 2009 21

Safetyand skillsProf Alan Merry ONZM“ Healthcare is in transition from a relativelyineffective cottage industry characterisedby generalists to a future in which specialisedexpertise in technologically sophisticatedproceduralism will increasingly defineacceptable standards of care.”It is generally accepted that the rate ofmortality associated with anaesthesiais steadily decreasing, and most peoplebelieve that anaesthesia today is verysafe indeed. 1However, there is legitimate debateabout the validity of the data to support thiscontention. 2 The best data on anaesthesiamortality in the world has been collectedunder the auspices of ANZCA, 3 andthe latest triennial report on “Safety ofAnaesthesia” will complete 20 years ofuninterrupted data from several statesof Australia.Unfortunately in some states, andin New Zealand, mortality committeeshave not been functioning well (or at all).Furthermore, even in those states that are,the data pertain primarily to the first 24 or48 hours after anaesthesia, whereas mostpeople would probably want to know theirchances of being discharged from hospitalin good health.In the future more comprehensivemortality reporting will be essential. Incombination with the ANZTAD Committee’sinitiatives to revitalise anaesthesia incidentreporting in our region, this will allow us toidentify continuing areas of major concern,to monitor progress in our continuingefforts to improve one of the safestanaesthesia services in the world today,and to provide the information needed foranaesthetists to partake in debating thewider issues in healthcare.One of the most important contemporaryinitiatives in promoting safety in theoperating room is the introduction of athree-phase Surgical Safety Checklist (thechecklist) developed by the World Alliancefor Patient Safety of the World HealthOrganisation (WHO) in the Safe SurgerySaves Lives initiative. 4Anaesthetists have contributedsubstantially to the development andevaluation of this checklist, and ANZCA isliaising with ASA, NZSA, RACS, and otherorganisations in Australia andNew Zealand to endorse and promulgatethe use of this safety tool, with itsparticular emphasis on teamworkand communication.In addition, another important outcomefrom the Safe Surgery Saves Lives initiativehas been the first estimate of the numberof surgical procedures undertaken aroundthe world every year – about 234 million,which substantially exceeds the numberof births. 5 These procedures are veryunevenly distributed, and it is clear thatmany patients around the world are failingto get essential surgery while others arehaving operations that are not justified.The adequate provision of safe surgeryaround the world is a priority for thefuture, and this will clearly depend onthe availability of safe anaesthesia.Unfortunately there are many areas whereanaesthesia providers have no medical ornursing qualifications, relatively limitedtraining, and hopelessly inadequatefacilities. 6 Anaesthesia mortality rates insome of these regions are unacceptable. 7-9At an even more fundamental level, thepre-requisites for health and wellbeingare factors such as peace, adequate food,education, empowerment of women, andrespect for human rights and equity. 10Regular work is also very important, andthe recession presently deepening in mostparts of the world is likely to place anincreased burden on healthcaresystems everywhere.Anaesthetists have built their reputationfor promoting patient safety substantiallythrough the development of anaesthesia asa respected branch of independent medicalpractice underpinned by an enviabletrack record of training, and because oftheir commitment to research. The role ofanaesthesia organisations has also beenof pivotal importance – in particular thedevelopment of ANZCA as an independentcollege. The birth of a new College inintensive care is another step along thisroad and the importance of a qualificationfrom the Faculty of Pain Medicine willcontinue to increase in the future.To a considerable extent, the formalmove to demonstrated qualificationsin specialised areas is a reflection ofincreasingly high expectations frompatients, and these expectations applynot just in intensive care and painmanagement, but in anaesthesia as well.Expectations that skills and competencehave been maintained since qualificationwill also increase. Healthcare is intransition from a relatively ineffectivecottage industry characterised bygeneralists to a future in which specialisedexpertise in technologically sophisticatedproceduralism will increasingly defineacceptable standards of care. It will becomeincreasingly unrealistic for generalistanaesthetists without relevant training andexpertise to provide occasional intensivecare services to critically ill patients.It will also become equally unrealisticfor intensivists to maintain occasionalanaesthesia practices.The adoption of ultrasound byanaesthetists to eliminate their traditionally“blind” approach to invasive procedures isjust one example of the pressure to improvethe ways in which anaesthesia is provided.Similarly, skills in fibre-optic laryngoscopywill not be seen as optional in anaesthesiafor much longer, and echocardiographyis likely to become a requirement for theevaluation of patient’s cardiac fitnessfor surgery.Pressure on the specialty to conform tobest practice protocols will increase, andpractices deemed idiosyncratic will becomeless acceptable. The risk, feared by many, isthat the well rounded medically qualifiedanaesthetist may come under threat fromnarrowly qualified practitioners withgood technical skills and a willingnessto standardise.In my view, however, we will still needthe broadly based medical expertisetypical of anaesthetists in Australia andNew Zealand today. A key principle of thechecklist is teamwork, and broadly trainedmedically qualified anaesthetists will beideally placed to broker teamwork in theperioperative environment. In particular,anaesthetists will need to continue tounderstand the needs for postoperativeintensive care and sophisticated painmanagement and to ensure that these aremet (albeit, not always by themselves).The credibility of our claim on the fieldof perioperative medicine will depend onhow well we adopt new technology, and onthe overall care we provide for our patients(often through liaison with others), but itwill also depend on how assiduously wecontribute to the debate about wider issuesin healthcare. We need to be advocates foradequate access to appropriate and safesurgery, not just in our region, but globallyas well.22The ANZCA Bulletin June 2009

BroadeningrolesDr Vanessa BeavisWe also need to take part in the debateabout health economics, not just globally,but also (with increasingly difficult times)in Australia and New Zealand. As we moveinto the future, all doctors will need tohave a wider view of the appropriatenessand cost-effectiveness of healthcare theyare providing than they have in the past.Anaesthetists will have to take part in thisdebate, and to lead it, they will need therelevant data.Prof Alan Merry ONZMHead of Department of AnaesthesiologyFaculty of Medical and Health SciencesUniversity of AucklandReferences:1. Cooper JB, Gaba D. No myth: anesthesiais a model for addressing patient safety.Anesthesiology. 2002;97(6):1335-1337.2. Lagasse RS. Anesthesia safety: model ormyth? A review of the published literatureand analysis of current original data.Anesthesiology. 2002;97(6):1609-1617.3. Gibbs N. Safety of Anesthesia in Australia. Areview of Anaesthesia Mortality 2000-2002.Melbourne: Australian and New ZealandCollege of Anaesthetists; 2006.4. Haynes AB, Weiser TG, Berry WR, Lipsitz SR,Breizat AH, Dellinger EP, Herbosa T, Joseph S,Kibatala PL, Lapitan MC, Merry AF, MoorthyK, Reznick RK, Taylor B, Gawande AA, SafeSurgery Saves Lives Study G. A surgical safetychecklist to reduce morbidity and mortality ina global population. New England Journal ofMedicine. 2009;360(5):491-499.5. Weiser TG, Regenbogen SE, Thompson KD,Haynes AB, Lipsitz SR, Berry WR, GawandeAA. An estimation of the global volumeof surgery: a modelling strategy based onavailable data. Lancet. 2008;372(9633):139-144.6. Walker I, Wilson I, Bogod D. Anaesthesiain Developing Countries. Anaesthesia.2007;62(s1):2-3.7. Ouro-Bang’na Maman AF, Tomta K,Ahouangbevi S, Chobli M. Deaths associatedwith anaesthesia in Togo, West Africa.Tropical Doctor. 2005;35(4):220-222.8. Heywood AJ, Wilson IH, Sinclair JR.Perioperative mortality in Zambia. Annalsof the Royal College of Surgeons of England.1989;71(6):354-358.9. Hansen D, Gausi SC, Merikebu M.Anaesthesia in Malawi: complications anddeaths. Tropical Doctor. 2000;30(3):146-149.10. United Nations. Jakarta Declaration onLeading Health Promotion into the 21stCentury. 4th International Conference onHealth Promotion. Available at: http://www.who.int/hpr/NPH/docs/jakarta_declaration_en.pdf Accessed 5th July 2006.Anaesthetists are going to have to get outof the operating room and into other placesto practice medicine so they are not justbeing seen as technicians.Many people do not realize thatanaesthetists are highly trained medicalphysicians with vast skills and experience.In a way, anaesthetists are victims of theirown success. It appears that anaesthesiais so safe nowadays “that anyone can doit”, whereas we know that it is only safebecause of the high standards and qualityof care, and training involved.We have a marketing problem in thesense that we have a very short time tosee a patient and usually on the day ofsurgery. Every pre-operative consultationis an opportunity for anaesthetists todemonstrate the fact we are highlyskilled doctors.In our hospital we do about 50,000anaesthetics a year so that is 50,000opportunities to convey some keymessages. We have a role beyond theoperating room managing physiology tomanaging pain and playing a preventativerole with patients postoperatively.Anaesthesia must go into perioperativemedicine because unless the specialtyexpands it will contract and others willmake decisions for us. There is going to besuch a huge demand for patients to haveanaesthetics and we need to examineways to provide that level of service to thecommunity in the future.Anaesthetists are now more involvedin systems of value management,organizational learning and clinicalgovernance. We are quite good at takinga helicopter view of an organization asopposed to just caring for patients so thatoverall perspective in the pre-op andpost-operative setting will become moreimportant in the years ahead.Dr Vanessa BeavisDirector of Anaesthesia andOperating RoomsAuckland City Hospital“It appears that anaesthesia is sosafe nowadays ‘that anyone cando it’, whereas we know that itis only safe because of the highstandards and quality of care,and training involved.”The ANZCA Bulletin June 2009 23

Governmentand workforceEmeritus Professor Garry Phillips AMThe Government of Australia has beentracking the Colleges for many years,and first began publishing data providedby them, and obtained from othersources in 1996, when the first MedicalTraining Review Panel (MTRP) reportwas published 1 , along with the firstpublication by the Australian MedicalWorkforce Advisory Committee (AMWAC)on supply, requirements and projectionsof the Anaesthetic Workforce in Australiacogently revised in 2001 2 .Since 2005, when the ProductivityCommission’s Research Report onAustralia’s Health Workforce hit thestreets 3 , the Council of AustralianGovernments (COAG) agreed to eight of itsrecommendations, modified eleven, anddid not support two. As a result, AMWACwas abolished, and there has been a hiatusin reliable medical workforce data untilsome was included in the National HealthWorkforce Taskforce (NHWT) report byKPMG in April, 2009 4 .In a section entitled “EmergingStrategies”, a brief and variable qualitysummary is made of trends in the UK,Canada and the USA with regard to“physician assistants”, but it ignoresthe extent to which anaesthetists andintensivists have worked for decadeswith nursing teams in Australia in areaslike pre-anaesthesia clinics, duringanaesthesia, in the recovery roomand in intensive care units.A research paper published in March2008 from the Social Policy section of theAustralian Department of ParliamentaryServices 5 repeats much of the informationconsidered by, but interpreted quitedifferently, in a well-researched paperpublished by Thompson, Phillips andCousins in 2007 6 . It is of more thanpassing interest that while the role of“nurse anaesthetists” in several countrieswas explored by the Royal College ofAnaesthetists and the NHS in 2002, witha view to adoption in the UK of “nurseassistants”, this had not progressed farby 2008 7-8 .One reason given for recommendingcontinuation of training of nurse assistantsin the UK is said to be “in the context ofdecreasing trainee numbers, hours ofwork and a higher expectation oftraining quality”.While nurses are in short supply inAustralia, and likely to remain so fora long time, an ambitious program forexpansion of medical student numbers inAustralian medical schools is already inplace. Commencing medical students areprojected to reach 3074 by 2010 (from 1470in 2002). This is a much higher percentagethan the increase in commencing nursingstudents in the same period (from 8042 to13,895). The flow-on effect of increasedmedical graduates to vocational trainingwill result in a large increase in medicalspecialist anaesthetists.In addition, anaesthesia in Australiais attracting increasing numbers ofInternational Medical Graduate Specialists(IMGS). A paper published by the NHWTin September, 2008 sees no definite end tothe need for IMGS 9 . Since 2002, the numberof IMGS who have been accepted into theprocess agreed by the Australian MedicalCouncil (AMC)/medical boards/councilsand the medical colleges and have eitherachieved Fellowship of the Australianand New Zealand College of Anaesthetists24The ANZCA Bulletin June 2009

“Commencing medical students are projectedto reach 3074 by 2010 (from 1470 in 2002). Thisis a much higher percentage than the increasein commencing nursing students in the sameperiod (from 8042 to 13,895). The flow-on effectof increased medical graduates to vocationaltraining will result in a large increase in medicalspecialist anaesthetists.”(FANZCA) or are well on the way to doingso, has been increasing. For the pastfew years, FANZCAs by this route haveaveraged between 22 and 25 per annum.But the rules are changing again –MTRP is re-inventing itself, and we nowhave the NHWT, the Health WorkforcePrincipal Committee (HWPC), and a recentdiscussion paper raises important issuesabout clinical placement, governance andorganization for all health professionals 10 .Source material included in this paper istaken from the Clinical Training Agency inNew Zealand, and from the UK NHS NextStage Review “A High Quality Workforce”.As would be expected, the clinical trainingdiscussion paper concentrates on theincreased numbers of health professionalsabout to enter the pre-vocational trainingworkforce, and does not yet address theissue of specialist training, althoughputative models are canvassed.Returning to ANZCA, after theAustralian Competition and ConsumerCommission (ACCC) completed its review ofthe Royal Australasian College of Surgeons(RACS), the ACCC and the Australian HealthWorkforce Officials Committee (AHWOC)reviewed the specialist medical Colleges,and published their report in 2005 11 . ANZCAhas done well in complying with allrequirements, and has also participatedin the program recommended by theEnhanced Medical Education AdvisoryCommittee 12 , supporting more applicationsfor training in the private sector than wereeventually funded by the government.With the projected increase in traineenumbers in a very few years time, it seemshighly unlikely that “training in private”will provide an adequate solution, andincreases in funding for trainees in publichospitals, and increases in specialistnumbers to supervise and teach them willbe required.From ANZCA’s perspective, all of theabove movements, combined with nationalregistration and national accreditationfrom 2010 will require serious planning toensure that there are enough anaesthetiststo keep providing the high quality patientcare the community will continue toexpect. It seems likely that the increasingnumber of Fellows in Australia, both bytraining and examinations, and via theIMGS pathways, and the program of theJoint Consultative Committee of ANZCA,the Royal Australian College of GeneralPractitioners and the Australian College ofRural and Remote Medicine (the latter notavailable in the UK) ably assisted by nursesin their traditional, and perhaps expandedroles, will avoid the need for radicalrestructuring of the anaesthesiaworkforce here.It is be hoped that when reviewed inanother year or so, it will be seen thatgovernment and its new agencies havesupported the Colleges, which producemedical specialists of high quality, a solidplank in our health system.Emeritus Professor Garry Phillips AMFormer ANZCA PresidentReferences1. Medical Training Review Panel EleventhReport, Australian Government Canberra 2007.2. Australian Medical Workforce AdvisoryCommittee, The Specialist AnaesthesiaWorkforce in Australia. Supply andrequirements, 2000 – 2011 Sydney 2001.3. Productivity Commission, Australia’s HealthWorkforce. Canberra 2005.4. KPMG, National Health Workforce Taskforce,Health Workforce in Australia and Factors forCurrent Shortages. 2009.5. Jolly R, Health Workforce: a case for physicianassistants? Research Paper 24, Social PolicySection, Parliamentary Library Canberra 2008.6. Thompson WR, Phillips G, Cousins MJ,Anaesthesia underpins acute patient care inhospitals. Australian Health Review 31 (Suppl1) 116 – 121.7. Grayling M, Thomas P, Lillie HJ, WilkinsonD, Physicians’ assistants (anaesthesia) –the Exeter experience. Royal College ofAnaesthetists’ Bulletin July 2008: 2570 – 2573.8. Association of Anaesthetists of GreatBritain and Ireland and the Royal College ofAnaesthetists, Joint Statement on physicians’assistants (Anaesthesia) – supervision andlimitation of scope of practice. www.aagbi.org9. Carver P, National Health WorkforceTaskforce, self sufficiency and InternationalMedical Graduates – Australia,Melbourne 2008.10. National Health Workforce Taskforce,Health Education and Training, clinicalplacements across Australia: capturing dataand understanding demand and capacity,Melbourne 2008.11. Australian Competition and ConsumerCommission and Australian HealthWorkplace Officials’ Committee, Reviewof Australian Specialist Medical Colleges,Canberra 2005.12. Department of Health and Ageing, ExpandedSettings for Medical Specialist Training,Australian Government Canberra 2006.The ANZCA Bulletin June 2009 25

Perioperativeand pain medicineProf Michael Cousins AM“A crucial aspect of enhancedknowledge of pain is the verydistinct possibility that we will beable to identify ‘at risk’ patientswho are likely to progress fromthe acute pain situation topersistent pain.”BackgroundDuring the last 10-15 years I have had anopportunity to have broad ranging contactwith Government and non Governmentorganisations outside of ANZCA as a resultof my appointment to a number of positionssuch as: NHMRC Councillor, Dean of theFaculty of Pain Medicine, Vice-Presidentand President of the College, Chair ofthe Committee of Presidents of MedicalColleges and Councillor, The AustralianMedical Council. Fellows will be pleasedto hear that without exception I receivedstrong feedback that ANZCA was viewed inan extremely positive light. This image hadarisen from outside perceptions of our verystrong training and examination process,our development of professional documentsand other professional activities. Over thelast decade ANZCA has attained statusof equivalent level to the major collegessuch as RACP and RACS. However we areabout to have perhaps the greatest changein healthcare in our lifetime as a result ofwork by the Health Reform Commissionand related bodies. Several MedicalColleges are moving rapidly to positionthemselves for these changes and ANZCAwill need to do the same if it wishes tomaintain or indeed enhance its key role inhealthcare. I believe that there are somevery major opportunities and even threatsfor ANZCA and my purpose in this briefarticle is to comment on a few of these.Perioperative medicineFast tracking of surgical patients continuesto evolve at a rapid pace, that in somerespects has outstripped the scienceand practicalities of this approach.Undoubtedly anaesthetists have a greatdeal to offer in the field of perioperativecare and this is why I appointed thetaskforce on this area during myPresidency which evolved into an ANZCACommittee. However, physicians have animportant and obvious role to play and itis my view that ANZCA should collaboratewith RACP in the development of thescience and practice of perioperativemedicine. From time to time I talk to myfriend and colleague Ron Miller in theUSA about developments in America inthis field and it is clear that perioperativemedicine is evolving rapidly with manyanaesthesiologists taking leadershiproles. The ANZCA curriculum will need toevolve to include the key knowledge baseof perioperative medicine and ANZCAresearch should encompass the effectsand management of various disease statesin the perioperative setting. Whether welike it or not, the perioperative medicinespecialist will be in an unparalleledposition to project a clear image of theknowledge and expertise of thespecialist anaesthetist.Pain medicinePain medicine is now an independentmedical specialty, bringing the knowledgeand expertise of five separate medicalspecialty bodies together. This is a uniqueprofessional body in the world at presentand represents a very major asset toANZCA in collaboration with RACP, RACS,RANZCP and AFRM. All ANZCA Fellowsand Trainees should benefit from enhancedknowledge of the mechanisms andtreatment of pain. Indeed this knowledgeshould be applied to the management ofmany patients in the perioperative phase.A crucial aspect of enhanced knowledgeof pain is the very distinct possibilitythat we will be able to identify ‘at risk’patients who are likely to progress fromthe acute pain situation to persistent pain.The implications of this will be that specialtechniques of acute pain management willbe applied to provide a very cost effectiveintervention because of the reduction inthe large disease burden that is currentlyrepresented by persistent (chronic) pain.Thus, there will need to be timely updatingof the knowledge base of all anaesthetistswith respect to pain mechanisms andtreatment. It seems so simple, howevercross fertilisation from one specialty bodyto another, even in the same college, hasoften been found to be lacking. A startingpoint may well be to ensure that theFaculty’s role in the College is appropriate.The name of the CollegeAnother taskforce that I appointedduring my Presidency was ‘The Nameof the Specialty”. In retrospect this wasnot an optimum choice of title since thereal issue for ANZCA is the name of theCollege. In my many interactions withpeople outside the College, I have rarelymet an individual who could pronounce‘anaesthetists’. Certainly the mediaalso have enormous problems with thisword. This is not a good starting point fora College that is already in difficulty inprojecting to the general community whatit actually does. As noted above, it is mucheasier to project perioperative medicine,pain medicine and dare I say it intensivecare medicine! In any case it is imperativethat the word ‘Medicine’ appears in thename of the College, in my view. Thuskeeping it simple, I would suggest that theCollege’s name be changed to “Anaesthesia& Pain Medicine”. At least anaesthesiais a term to describe the practice of ourspecialty and this matches the word painmedicine. Another advantage is that“Anaesthesia & Pain Medicine” appears tobe a shorthand for Anaesthesia Medicineand Pain Medicine. I would much preferanaesthesiology in the title since there aremany medical specialties that are ‘ologies’.The Australian Society of Anaesthetistscould retain ‘Anaesthetists’ which I knowis dear to the ASA. From the point of viewof the Faculty of Pain Medicine, I think it isonly fair that its role within the College berecognised by including pain medicine inthe name of the College. ANZCA has to bevery careful that a train of events similar tothat surrounding the Faculty of IntensiveCare Medicine, does not occur in the caseof pain medicine.Election of College CouncilMuch has been done within ANZCA toensure that the College Council, andindividual Councillors, act in accordancewith the requirements of regulatory bodies.Councillors all now recognise that theyare members of the Board of a mediumsized company. However, the process of26The ANZCA Bulletin June 2009

An anaesthetist-ledPerioperativeCare Unit (PCU)Prof Paul Myleselection of College Councillors is in noway in keeping with the manner in whichcompany boards are formed. Granted theCollege is not the same as a commercialoperation, however there are manyimportant similarities. It is my belief thatthe College must move ahead in developinga process for identifying individuals whowill bring to the College Council the verywide range of skills that are now requiredon the board of any company. This has nowbeen achieved by the College of Physicianswith surprisingly little in the way of majorproblems. I strongly recommend thatANZCA examine the process that wasutilised in moving towards what is now“the Board of RACP”. Of course this mustbe done with very close consultation withall Fellows as was the case in RACP.I should end by saying that all of theabove represents my personal perspectiveand is intended to create discussion anddebate in the interests of ANZCA. I amconfident that the College has the peopleand resources needed to move forwardwith the same success in the next 20 yearsthat has been achieved over the pasttwo decades.Prof Michael Cousins AMDirector, Department of Pain Managementand Research, Royal North Shore HospitalIntensive care units (ICU) developed fromthe speciality of anaesthesia, as a logicalextension of the operating theatre recoveryroom. Intensive (or critical) care medicineis now an independent and vibrant specialty.Modifications to ICU include thestep-down or high dependency unit(HDU), largely to improve cost-efficienciesbecause of flexible staffing and lower-levelmonitoring and therapy. In most countriesICU and HDU bed access have becomeincreasingly limited because of reductions(in real terms) in funding and insufficientICU-trained nursing staff.This has been compounded by anageing population and their concomitantcomorbidity, often undergoing high-risksurgery. At the same time there are growingnumbers of patients with morbid obesityand sleep apnoea. ICUs are unlikelyto cope.Some hospitals have created additionalcritical care beds within an extendedrecovery room environment; this issometimes labelled a post-anaesthesiacare unit (PACU). But in the majority ofcentres a PACU is no more than a standardrecovery room by another name. Thisconcept could be expanded further, asa true perioperative care unit (PCU), inorder to improve the quality of ongoingpostoperative care of high risk patientin a dedicated environment close to theoperating theatre for say, 24 to 48 hoursand perhaps incorporating preoperativeoptimisation.An anaesthetist-led PCU could improvethe safety of patients recovering frommajor surgery. Unlike a typical surgicalward, they can receive a higher level ofmonitoring and vasoactive therapy, usingexperienced nursing staff in a HDUstyleenvironment, and easier accessto senior anaesthetic and surgical staffin close proximity to theatres. This willprovide a more reliable postoperative careenvironment and so can increase surgicalthroughput because of an improvedability to accept complex patients from thehospital waiting list. This should reducehospital stay because of the opportunityto use sophisticated analgesic regimensand so facilitate earlier mobilisationand probably reduce postoperativecomplications. The latter would includea reduction in unplanned admission toICU. A PCU should reduce staff stress andworkforce requirements - why shouldinterns be primarily responsible for suchpatients over the first night after majorsurgery? This is likely to reduce adverseevents and need for medical emergencyteam (MET) calls. A PCU provides a readyenvironment to administer continuouspositive airway pressure therapy in sleepapnoea and morbidly obese patients.Most high-risk patients declarethemselves on the first night after majorsurgery. Respiratory, fluid, and analgesicdemands are typically at their highest andyet medical staffing levels overnight areat their lowest and most inexperienced.If a PCU patient deteriorates they will bedetected earlier, managed better and canthen be either stabilised or transferredto ICU. For the majority of patients whohave an otherwise uneventful recoveryfrom major surgery, they can be reviewedon the day after surgery and usually bedischarged to a general surgical wardfor ongoing care and recovery untilhospital discharge.Prof Paul MylesDirector, Department of Anaesthesia andPerioperative Medicine Alfred Hospitaland Monash UniversityIn part two of the Bulletin’s specialfeature on the future of anaesthesia,ANZCA will look at how technology andpharmacology will provide advancesin anaesthesia and what someinternational commentators aresaying about the future of the specialty.We would like to hear your views.Email: bulletin@anzca.edu.auThe ANZCA Bulletin June 2009 27

advertisement28The ANZCA Bulletin June 2009

advertisementThe ANZCA Bulletin June 2009 29

fellowship affairsPrivate practice:improving patient careTraditionally, private practitioners have seen their patients for the first time on the night beforesurgery; this has changed with day of surgery, staggered admissions making appropriatepreoperative evaluation difficult. Four anaesthetists have outlined how different structures can beimplemented in private practice to facilitate the perioperative care of patients. There are two grouppractices (ACT and Tasmania), a solo practitioner (metropolitan Sydney) and an informal groupunited by working with the same surgeon (metropolitan Sydney). Each has developed a structurein which to evaluate patients and facilitate communication between different team members.St Vincent’s PrivateHospital, SydneyThe anaesthetists of St Vincent’s PrivateHospital in 1989 had the foresight topurchase rooms off the plan of the StVincent’s Clinic when it was built next tothe hospital.These rooms were designed withspace for four secretaries, two consultingrooms, a library/ lounge and a kitchen.The rooms have not only provided adepartmental centre through which alllists are coordinated and after-hoursrosters maintained but also enable theanaesthetists to run a pain clinic and a preanaesthesiaconsultation service plus, forthose who wish, there is a billing servicevia an associateship.In addition, St Vincent’s Private Hospitalthree years ago opened a day of surgeryadmission ward that the anaesthetistshelped design. It has five consultationrooms.There is also a pre-admission nursingclinic that sees patients pre-operatively.In my practice I have an afternoonnearly every week set aside to see patients.I aim to see all my patients having majorsurgery, or who have significant illnesses,in my rooms some days prior to theirsurgery. I dovetail this with their visit tothe pre-admission nursing clinic. Afterseeing nurses where they are processed,weighed and have blood pressure, pulse,temperature and urinalysis taken, ECGdone if indicated and nursing informationprovided about their admission, they thencome to my rooms to see me.I have their nursing information,admission information from their surgeonand their old notes. I not only have timefor a thorough anaesthesia assessment butI can discuss with them their anaestheticincluding the risks, provide them writteninformation, an “Anaesthesia and You”brochure and a PCA brochure plus mysecretaries provide them with a writtenestimate of the fees which I can alsodiscuss with them. If needed, I can arrangefurther tests or consultations with otherspecialists.After leaving, they have any requiredblood tests and radiology, the results ofwhich I see prior to their anaesthesia. Thisenables even the most complicated patienthaving the most involved surgery to beadmitted on the day of surgery with meconfident that they are fully prepared fortheir anaesthesia.For patients who are ASA 1 and 2 havingreasonably straightforward surgery I seethem in the Day of Surgery Admission wardbefore the morning or afternoon sessioncommences. They are posted an estimateof the anaesthesia fee.I endeavour to see my admittedpatients post-operatively the next day tofollow up particularly on pain and fluidmanagement.There are, I believe, many advantagesto seeing patients in rooms some days priorto their anaesthesia.First, I believe it is simply bettermedicine. In a non-rushed, efficientenvironment significant numbers ofpatients can be thoroughly worked up priorto their anaesthesia. There are, therefore,fewer cancellations and fewer tests areordered, avoiding the shotgun approachof some surgeons when ordering tests. Ibelieve also there are likely to be betteroutcomes due to better preparation.Second, it enables the anaesthetist todevelop a relationship with the patient. Iam wearing a suit when they meet me inthe consulting rooms. It is very professionaland, I believe, far better for the image ofanaesthetists than the cursory chat at thebedside while dressed in scrubs.Third, it serves to greatly improve cashflow and reduce bad debts. The patientsare fully informed about the costs well inadvance of their anaesthesia.Finally, it is far better for my lifestyle tobe seeing patients efficiently in my roomsduring the day than to be scouring thewards trying to find patients, notes, oldnotes, X rays and results of investigationsafter hours and on weekends.Dr Gregory J DeaconSt Vincent’s Private Hospital, Sydney30The ANZCA Bulletin June 2009

Hobart AnaesthesiaGroupThe Hobart Anaesthesia Group (HAG)is an organization of some 24 associateanaesthetists and three “locum”anaesthetists. It was formed in theearly 1960s as a two-member group andhas operated continuously since. HAGprovides anaesthesia for approximately80 proceduralists including all surgicaldisciplines except cardiac as well asanaesthesia for endoscopy, imagingand emergency procedures. As part ofthis service, we also provide emergencyanaesthesia cover 24 hours a day,365 days a year.HAG employs 10 staff (seven FTE)at its operations base which is locatedindependently of any hospital. The “rooms”have been expanded in the last 10 yearsand now include five consulting rooms,and office space for reception, accountprocessing, debt collection, as well asco-ordination of lists and pre-operativevisits. There is also a meeting room, libraryand practice manager’s office. The numberof staff has expanded dramatically inthe last 10 years (corresponding with anincrease in number of anaesthetists, plusthe introduction of informed financialconsent (IFC) processes and the growth inpre-hospital pre-anaesthesia assessments).We currently see some 120-150 patientsper week in a pre-anaesthesia assessmentsetting in our rooms.About 10 years ago, a decision wasmade by HAG anaesthetists that, due to theemergence and growth of day-of-surgeryadmissions(DOSA) we would have tore-evaluate the way complex cases werebeing assessed prior to anaesthesia. Inorder to allow sufficient time for appropriateassessment, further specialist referraland investigation where necessary and toavoid late cancellations and disruptionsto operating lists the decision was takento organise pre-anaesthesia assessmentsin our rooms for all patients undergoingmajor surgery (eg. joint replacements,vascular surgery, bariatric surgery, LUSCSs,hysterectomy, etc) or those patients withmajor medical problems. This pre-hospitalprocess also facilitated appropriateinformed consent for patients (which alsoencompassed informed financial consent).The process that now has beenestablished is: all complex medical,surgical, or anaesthetic cases must bereviewed (wherever possible) by ananaesthetist as soon as practicable, usually1-2 weeks prior to the planned procedure.This includes major joint surgery, LUSCS,laparoscopic gastric banding and complexbowel surgery, patients with complexmedical conditions such as Type 1 or 2IDDM, significant IHD and/or CCF,as well as known difficulties withprevious anaesthesia.Cooperation with both proceduralists’rooms and hospital “booking offices”/operating theatre coordinators is essentialand lines of communication need to remainopen. All of our proceduralists are informedof our preferred system for pre-anaesthesiaassessment. and a reminder letter is usuallyre-sent annually.The proceduralist’s rooms now liaisewith our pre-anaesthesia co-ordinatorand an appointment is made with amember of HAG. Our rooms then sendout a confirmation letter which includesinformed financial consent and an“anaesthesia brochure” prior to arrivingfor a pre-anaesthesia assessment. Thepatient, having filled in the healthquestionnaire, will have their personaldetails checked for the billing system andbe asked to sign a privacy agreement (sameas for any hospital) by the office staff. Theconsultation then takes place, generallylasting anywhere between 10 and 30minutes, although the more complex casesoften take up to an hour. Notes are madeon hospital anaesthesia records, indicatingthe type of anaesthesia, what type of intraoperativemonitoring may be likely, and thelikely post-op destination of the patient.During the consultation, other specialistssuch as intensivists, cardiologists, orendocrinologists may be contacted to makeappropriate arrangements. The patient isthen given clear, consistent instructions.At the end of the interview, thecompleted pre-anaesthesia record isscanned into our computerized databaseof patient records and “tagged” to thepatient’s file. It is also faxed to the hospitalwhere the procedure will take placeand is incorporated into the patient’shospital record. The original is kept bythe anaesthetist so that it can be referredto as required and to ensure that it isnot mislaid.While this change in practice has beenrelatively costly to implement, the benefitsof early pre-hospital pre-anaesthesiaassessment have far outweighed the costsinvolved. All parties benefit with hospitalsbeing less disrupted by late cancellationsand delays in operating lists (awaitingthe anaesthetist “seeing patients”),communication between our practice andboth surgeons and hospitals has improved,allowing a greater degree of co-ordinationand therefore better planning andallocation of resources. Finally, and mostimportantly, our patients have benefitedallowing a very high rate of DOSA for majorsurgery and delivering an improved qualityof anaesthesia care.Dr Andrew Mulcahy,Ms Elizabeth Stanick,Dr Richard WaldronPhotos courtesy of Dr Michael MartynAbove: The computerised managementsystem and examples of patient informationbrochures; Patient reception at HobartAnaesthetic Group consulting rooms.The ANZCA Bulletin June 2009 31

fellowship affairsPrivate practice:improving patient careContinuedACT AnaesthesiaACT Anaesthesia Pty Ltd is based inCanberra and was established in 2003,the first private practice group in that city.Originally comprising four anaesthetists,the practice now has seven anaesthetistswho work across all specialties. Thebusiness operates as a service companycharging fees to the doctors on a perpatient basis.The main practice aims atestablishment were:1. The provision of high quality clinicalcare through good information collectionand use. We were particularly mindfulof the changing nature of our specialtyand the increased emphasis on patientthroughput. We were keen to mitigatewhere possible any adverse effectsthat this could have on patient care(and anaesthetist stress levels!)2. To create a service that would handlebilling and other administrativefunctions such as leave cover andlist management. In particular, wewanted a systematic approach topre-operative informed financialconsent whenever possible.3. To create a refuge away from the hospitalenvironment. We hoped to create aphysical place that would serve severalpurposes: to see our patients in a calmrooms environment; to facilitate andconsolidate our educational endeavoursand to have a forum to regularly discussany relevant professional issues.We specifically did not want to make ourlives more complicated or to increase ournon-clinical and out of hours workload.At inception we agreed to employboth nursing and administrative staffand to run two separate but interlinkedpractice domains. The nursing staff collectpreoperative clinical information frommultiple sources including the patients(via telephone), the surgeon’s rooms - whoprovide our patients with our practiceinformation – and GPs and hospitals. Oneof our major challenges was to establishpositive relationships and networks withall these groups unaccustomed to our moreproactive approach.Protocols have been developed to aidour staff in determining what informationis collected and how it is presented andused. In general the information includes:a completed perioperative questionnaire,relevant specialist and past medical oranaesthetic information. The consolidatedclinical information includes a summaryof financial information, which hasbeen provided to the patients by ouradministrative staff, and is available tothe anaesthetist at all times via a secureweb-based calendar system.Patients identified by any means,including direct referral, as requiringadditional preoperative input are seen inrooms consultation or managed by othermeans as necessary. The patients seen inthe rooms vary according to doctor practiceand preference. At least one consultant alsosees selected patients as house calls. Thesepatients are generally frail and elderly orhave mobility problems. The majority ofpatients receive a post-operative reviewtelephone call from the nursing staff.While establishing the office we hadto deal with issues such as practiceindemnity, IT security and medical recordsmanagement. Our communication flowwas based on readily available Internettechnologies to collect, manage anddistribute information amongst staffand doctors. We also use this to employstaff working remotely using VOIP andServer based technologies. Some of theless technologically inclined doctors nowappreciate the greater utility and realtime provision of information thissystem allows.Even if we could achieve a perfectweb-based environment we acknowledgethe need for a physical office. At the officethe practice members attend one regularcombined session per month for continuingeducation and addressing practiceadministrative issues. Attendance andactive participation at this meeting is seenas a vital part of maintaining the integrityof the group. Clinical and administrativestaff report to the meeting and providerelevant feedback or suggestions. We haverun several clinical practice audits andgenerally include a journal discussion aspart of the meeting. At the meeting wealso receive our collated monthlypost-operative reports. We view thecompleted information we receive foreach clinical episode very positivelyboth in terms of individual feedbackand also for its value in risk management.Six years on we feel we have progressedsignificantly towards our aims. We striveto ensure our practice is responsive to everchangingdemands. As a group we also paytribute to our staff who strive to translateour mission into reality.Dr John Ellingham(ACT Anaesthesia: Dr J Ellingham, Dr T Lo,Dr D Lu, Dr P. Martin, Dr C McInerney, Dr PMorrissey, Dr M Wilson)32The ANZCA Bulletin June 2009

Mater Private Hospital,SydneyOver the last 18 months we have developedand successfully implemented a PreanaestheticMedical Assessment Clinic(PMAC) at a large metropolitan privatehospital in Sydney which specializesin joint arthroplasty.Previously, the majority of patients wereassessed by a physician and admitted thenight before surgery.The retirement of a physician and ageneral sense that things could be “donebetter” encouraged us to develop ananaesthetic preoperative assessment clinicwith an aim to improve and streamlineperioperative care for our patients havingknee arthroplasty.Our team consists of seven VMOanaesthetists and two orthopaedicsurgeons specialising solely in kneesurgery. In the past 12 months 340 kneearthroplasties have been performed.The anaesthetists come from differentbackgrounds of teaching hospitals andprivate group practices but with thecommon link of working with the sametwo surgeons.When the patient has seen the surgeona date for the procedure is booked, usuallyabout six weeks later. The patient is givena pack consisting of a health questionnairedevised by ourselves, their signed consentform, admission assessment form andknee replacement clinical pathwaydocumentation as well as comprehensivepamphlets on knee replacement,physiotherapy and rehabilitation.Information is also supplied about spinalanaesthesia and patient controlledanalgesia.The surgeon at the time of bookingorders blood tests, ECG and CXR. Thepatient sends in the paperwork and thenmakes an appointment for the PMAC.At the PMAC we see on average of sixpatients in one session spending on average30 to 45 minutes with the patient. Thepatient health questionnaire, investigationsand correspondence are all available to us.We have formulated a hybrid anaestheticassessment form which forms the basis ofour paperwork. It is laid out in a way thatallows our colleagues to easily assimilateour assessment including an anaestheticplan, discussion of post- operativeanalgesia, discussion of risk, discussionof financial consent and if an intensive carebed has been pre-booked. As the patienthas a date for the procedure we can usuallytell the patient who the anaesthetist willbe. This also gives an opportunity tocontact and discuss the patient with themfrom the clinic.We have addressed the issue of out-oftownpatients by making a provision forthem to be seen the day after seeing thesurgeon. Their investigations are thenreviewed at a later date in the clinic.The alternative is a phone interview butagain with appropriate investigationsavailable to us.We have ready access to a numberof medical specialists should we feel thepatient warrants further investigationand this can usually be organized atshort notice.If the patient is deemed fit for surgeryfor that date a copy of our assessment issent to the surgeon’s rooms indicatingwe are happy to proceed and if day-ofsurgeryadmission is appropriate. A copyis also sent to theatres where it is availablefor review prior to the date of surgery.The responsibility for following up allinvestigations and consultations restswith the PMAC anaesthetist who informsthe surgeon’s rooms once the patient is fitfor surgery.This system has worked verywell and almost 100% of patients are nowadmitted on the morning of surgery and atthe same time reducing the cancellationrate from non orthopaedic factors.Given the success of the PMAC duringthe hospital redevelopment program,plans have been altered to provide a largerarea with two consultation rooms and awaiting room to accommodate the PMAC.We also have two nurses at the clinic,a physiotherapist and an occupationaltherapist.Most importantly, the patients haveconveyed their satisfaction to us. In general,they feel they are better prepared especiallywith the opportunity to have an informeddiscussion with an anaesthetist prior to theirhospital admission.Dr Paul SinclairMater Private Hospital, SydneyThe ANZCA Bulletin June 2009 33

feature: In the fieldSounds of Canadaby Dr Gavin PattulloFrom left: Dr Gavin Pattullo and hiswife Venessa at Lake Louise; relaxinglakeside in Ontario; Dr Pattullosnowboarding the Rockies; Dr Pattullowaiting for patients in the block room;Dr Colin McCartney demonstratesto a Fellow.Before starting this article I mustfirst make a disclaimer. I have nomisconceptions about my own lack ofphilosophical insight. This being the case,I do feel at liberty to make the followingcomment: life does take unexpected twistsand turns, some bad and some good.For my wife and me the “bad” was herdiagnosis of acute leukaemia three weeksbefore our wedding. The “good” was herremission with chemotherapy and thenthe profound realisations that developwith such an experience. For some, theserealisations may have already surfaced;for others, particularly when caught up inthe world of training and career building,they may be otherwise suppressed. Theserealisations are the type that mean whenyour wife is offered an opportunity toundertake PhD research with a worldleader – but in another country – you donot hesitate to drop everything and go.So that is the background to howI found myself heading to Toronto foran 18-month fellowship in general andregional anaesthesia. Well, admittedly,that is not the full story. Having alreadycompleted a Pain Fellowship and workedas a staff specialist for a couple of years therewas some reluctance to go “backwards”,as it were. I toyed (very briefly) with theidea of employment as a barista in thesummer and then spending the winterssnowboarding. But if you have ever triedNorth American coffee you will know alltoo well that their coffee standards do notdemand the services of a barista. But worsethan that; there are no mountains withincooee of Toronto, so take snowboardingoff the list of options.I chose Sunnybrook Hospital for myfellowship because of its strength inultrasound guided regional anaesthesiaand its reputation as being a great placeto work. The fact that its name made itsound like a retirement home was onlya little disconcerting.In Sunnybrook I found a dedicatedand cohesive team of staff anaesthetists,numbering close to 40 and most workingfull-time. The ultrasound guided regionalanaesthesia largely takes place ata dedicated upper and lower limborthopaedic hospital situated in downtownToronto. This location utilises a large blockroom where all patients are prepared forthe four operating rooms. The benefitof this design is that it results in a34The ANZCA Bulletin June 2009

large number of anaesthetic colleaguesbeing readily available within a smallspace, so making for a fertile learningenvironment. I am truly fortunate to havebeen able to interact in this way with DrColin McCartney, a humble Scotsmanwith inexhaustible patience who hasestablished himself as an authorityin the field of ultrasound guidedregional anaesthesia.Surgery at this location is almostexclusively performed under regionalanaesthesia with sedation. The full rangeof upper and lower limb blocks, bothsingle-shot and catheter techniques,are employed in achieving this. Needlesare successfully placed in many unlikelyplaces – and I thought my pain traininghad prepared me for most of the possibilities!A few years back in an effort to improveefficiency, the anaesthesia departmentmade a purposeful move to regionalanaesthesia away from a strict GA practice.This move achieved efficiency gains,partly by eliminating the delays due to GAinduction and emergence in the operatingtheatre. Regional anaesthesia also avoidedrecovery room backlogs through havingpatients practically ward-ready by the timethey left the OR. Efficiency gains throughearly discharge are aimed for by optimisingpostoperative analgesia, with an impressivearmamentarium of multimodal analgesics,and working this in with a comprehensiverehabilitation program.The reality, as with any job, is that itis not all tea and scones. There is alsothe real work to be done. This being theother lists that need covering up at themain Sunnybrook campus. For these listsI needed brawn (no theatre orderlies to helptransfer patients), brains to remember MACvalues (as there is no TCI in North America)and a production-line-like efficiency(no anaesthetic nurse to assist in set up).Overtime regularly exposed me to gunshotwounds from gang-related violence (notsomething I regularly see on Sydney’sNorth Shore) and far too much of thatNorth American coffee I derided earlier.The Canadian health care system isalmost wholly publicly funded. Inevitably,though surprisingly only recently, thishas led to the conflicts that occur whenescalating costs meet a limited budget. Bedshortages and rotating list cancellationsare a new experience for Canadian doctorswhile for a practitioner from NSW it is anall too familiar feeling.For a smooth transition into Canadianlife, an Australian needs to be aware ofimportant cultural differences, the mainone being that Canadians are incrediblypolite. The latest James Bond movie,Quantum of Solace, even made a subtlereference to this fact. In one of the finalscenes, Bond ambushes a Canadian doubleagent in her apartment, but after beingforgiven she is released from gunpoint.Leaving the room and knowing the deadlyfate of the partner she leaves behind, theagent turns to Bond and softly says in herCanadian accent “thank you”.After arriving in Toronto we stumbledupon a mini-boom of Australian and NewZealanders completing fellowships here.It seems that the closing down of theUnited Kingdom to Australian and NewZealand doctors by the European Unionemployment regulations has pushedmore of us towards Canada. It is easy tospot your countrymen here – they are theones despondently wandering around thesupermarket looking for Tim Tams.The benefits for those who do comeare wide ranging. Specifically for thoseinterested in ultrasound, coming to the citywhere a lot of it started offers the benefitsof quality real world training. Otherwiseback in your anaesthetic bay as youstand all alone and a million miles fromthe ultrasound courses with their buffedmodels, lays your reality; a patient who isaged, deconditioned and overweight – andan ultrasound machine that annoyinglykeeps disappearing.I encourage those interested andable to come to Toronto to enhance yourultrasound skills and take these new skillsback home to build upon the base alreadyestablished by a number of centres. Thoughfor this New South Welshman, the talentpool currently seems to be alarminglyskewed toward those south of the border!Anyone planning an overseas fellowshipshould carefully research the details andbear in mind that often the key informationcomes from those who have been before you.I would like to thank Dr Gil Faclierand all the members of SunnybrookAnaesthesia Department for their kindnessand support during my fellowship.Dr Gavin Pattullo completed medicalschool in Tasmania and then went on toundertake his training for FANZCA (2003)and FFPMANZCA (2004) at Royal NorthShore Hospital, Sydney. He has taken leavefrom his role as Staff Specialist and Directorof the Acute Pain Service at RNSH toundertake his fellowship in Toronto.The ANZCA Bulletin June 2009 35

fellowship affairs featureDiving and Hyperbaric Medicine:Roundtable discussionAnaesthetists play an important role indiving and hyperbaric medicine. We caughtup with three Fellows from Royal HobartHospital in a roundtable discussion.Dr Margaret Walker is medical co-directorof the Diving and Hyperbaric Medicine Unitat Royal Hobart Hospital, and a visitingspecialist in anaesthesia. Dr David Cooperis a staff specialist in intensive care, andhyperbaric medicine trainee, who hascompeted his training time and is planningto sit the Hyperbaric Medicine Certificateexamination this year. Dr Ian Maddox is ananaesthetic registrar in his fourth year oftraining, who is undertaking a six-monthterm in diving and hyperbaric medicine,and plans to sit his FANZCA part twoexam this year.How did you become interested indiving and hyperbaric medicine?MW: I first developed an interest whenI was an anaesthetic registrar. I was also akeen scuba diver and I was sponsored bythe hospital to do some training becausethey were in the process of setting upa new hyperbaric unit.DC: I was first interested in this fieldin about 1993 when I did an underwatermedical officers course with the RoyalAustralian Navy. I have an interest inenvironmental medicine (as a pilot) andit seemed like an interesting sideline tothat. Subsequently I developed that furtherwhen I became the registrar in hyperbaricmedicine in Hobart in about 2001.IM: Like Margaret my interest wasstimulated by my scuba diving hobby.I was also pointed in this direction bya few cases I had while working as anemergency department registrar where wesaw a couple of diving cases. I attended theRoyal Adelaide Hospital diving medicinecourse a couple of years ago which furtherinterested me and that’s what drove me intofinally trying to get a registrar position indiving and hyperbaric medicine.What is the structure of training indiving and hyperbaric medicine?MW: At the moment we have the ANZCAtraining scheme set up as a post-graduatequalification. We primarily aim it atsenior registrars or people after they have36The ANZCA Bulletin June 2009achieved their fellowship, but it’s actuallyopen to anyone who has a specialistqualification and that includes generalpractitioners (who are also recognisedas specialists by our College). In terms oftraining there are two two-week coursesin diving and hyperbaric medicine. Oneis predominantly diving medicine, whichis either at Royal Adelaide Hospital orat HMAS Penguin in Sydney, and theother one is predominantly non-divinghyperbaric medicine which is at thePrince of Wales Hospital in Sydney. Bothcourses are held annually. We requirethat trainees have done both of thosecourses at some stage. The formal trainingrequirement is actually a total of 18 monthsfull-time equivalent work in an accreditedhyperbaric unit. We expect a lot of peoplewill probably do six months full-timeand then accumulate the other twelvemonths as a part-time commitment, asmost people are already specialists whenthey’re doing their training. There is aformal examination which is both writtenand oral, as well as a formal project. Onceyou have achieved all of those things, youare eligible for the certificate in divingand hyperbaric medicine awarded bythe College. At the moment we are in theprocess of accrediting units around thecountry for training.IM: My aim is working towards theDiploma in Diving and HyperbaricMedicine that’s run by the South PacificUnderwater Medicine Society. This requiressix months full-time equivalent work ina diving and hyperbaric medicine unit,attendance at one of the courses Margaretmentioned and a formal research projectas well.DC: I’m in the process of preparingfor the college examination in hyperbaricmedicine. I did the South PacificUnderwater Medicine Society’s diploma,the six month diploma with a formalproject requirement, but then I decidedto cross-credit that into the College’sprogram and then continue to get the entire18 months worth of clinical time that’srequired. I’ve been doing that on a 0.2 FTEbasis for the last five years so I’m lookingforward to the College quiz later this year!Were there any difficulties in gaininga position for training?IM: I had no particular difficulty gettinga job here in Hobart. I had tentatively askedfor jobs previously when I lived in WesternAustralia in Fremantle. As a junior registrarat that time, senior registrars were givenpriority and it was popular. Certainly inWestern Australia and Hobart, I believethat if you wanted a job as a registrar inhyperbaric and diving medicine youwould be able to get one.DC: When I was initially looking fora registrar position back in about 2000,I looked in Sydney and Melbourne aspart of the process. At that time there wasa moderate amount of competition forpositions there. Outside those two centresthere seems to be an adequate number ofpositions for people who are interested.MW: From the College point of viewthe following hospitals are accreditedfor training: Prince of Wales Hospitalin Sydney, Royal Hobart Hospital andFremantle Hospital, and both the AlfredHospital and Townsville General Hospitalare well advanced in the accreditationprocess. At Royal Hobart we have one fulltimeposition for a registrar for a whole year

and we often split that into two six-monthjobs so we can accommodate two peoplein a year. At Prince of Wales, they rotateanaesthetic registrars through theirunit and in Townsville, which is aboutto apply for accreditation, they have sixmonth positions. At the moment they’remostly emergency medicine trainees goingthrough Townsville, but they can certainlyaccommodate anaesthetic trainees ifthere are any interested. Fremantle has aflexible arrangement for registrars to rotatethrough the unit. Royal Adelaide Hospitalis planning to apply for accreditation inthe near future, so there are a reasonablenumber of jobs around the country.Are there any problems in fulfillingtraining requirements?MW: The main issue is getting the 18months full-time equivalent. It’s fairly easyto get six months full-time experience inany of the units, but most people woulddo the other 12 months part-time so it willobviously take more than twelve monthsto complete. For example, David Cooperhere has been doing his extra twelvemonths over a five-year period by workingone day a week.IM: I suppose another area is getting asmuch exposure to patients with differentconditions for treatment. For example,intubated and ventilated patients are a rarecommodity in this unit but it’s somethingthat trainees need to get experience inmanaging. Unfortunately I haven’t had todeal with an intubated ventilated patientyet and apparently we only get about two tothree a year in this facility. The number ofinjured divers seems to be reducing as well.At the recent South Pacific UnderwaterMedical Society meeting, a number ofdelegates presented their data and thegeneral trend over the last few years isthat there are fewer divers presenting withdecompression sickness.MW: Which is good because it meansour diver education programme is gettingthrough to them.DC: But we’re doing ourselves outof a job in the process.MW: Although that’s not all we do.Diving medicine is a very small amountof our work. The bulk of our work ishyperbaric medicine and that’sactually increasing.What types of patients are treatedin the hyperbaric chamber?MW: Aside from diving injuries, ourpatients are predominantly those withproblem wounds. The largest patientgroup we treat at the moment would bepatients who have had radiotherapy andhave developed a radiation tissue injuryas a result, ranging from skin ulcerationthrough to radiation proctitis or cystitis.The next largest group would be diabeticswith foot or lower limb ulceration, and inthese two conditions we have considerablelevel one experimental evidence indicatingthat hyperbaric medicine is efficacious.Aside from that we do treat otherconditions including acute necrotisinginfections, cerebral arterial gas embolism,carbon monoxide poisoning, compromisedflaps and grafts amongst other rarerconditions. We don’t treat any conditionsfor which there is no evidence that thereare benefits, so things like multiplesclerosis and cerebral palsy which aretreated a great deal in the USA and partsof the UK we would not treat here becausethere’s no evidence of efficacy. We are quitestrongly evidence based in the way wecarry out our practice which is necessary tomaintain credibility and status within themedical community.Diving and hyperbaric medicine as aspecialty does seem quite different fromanaesthesia. Can you describe the areasof similarity and comment on the areasof difference?DC: The areas of similarity are notnecessarily few and far between. Theyarise predominantly in the necessity for thepractitioner to have a sound understandingof the behaviour of gases and vapoursunder various environmental conditions.There is no other specialty group whichhas the same fundamental understandingof physics and physiology which arenecessary to the practice of diving andhyperbaric medicine other thanthe anaesthetist.Above from left: Dr Ian Maddox,Dr Margaret Walker and Dr David Cooper;The Royal Hobart multiplace chamber.The ANZCA Bulletin June 2009 37

fellowship affairs featureDiving and Hyperbaric Medicine:Roundtable discussionContinuedAt a purely theoretical level,anaesthetists are best positioned toperform this job. With regard to the actualanaesthetic skills, the sort of generalpurpose anaesthetic skills like intubationand ventilation and the maintenance ofanaesthesia during procedures are possiblyof slightly less relevance. But again, ananaesthetist is a very useful individualto have around the chamber when youare dealing with critically-ill patientspotentially coming down from the intensivecare unit, ventilated with invasive linesand requiring for organ support during thehyperbaric treatment, so I would see thoseas areas of similarity.IM: Diving and hyperbaric medicineitself is actually two rather differentspecialties. Diving medicine involves takingan acutely unwell, acutely injured patientand coming to a differential diagnosisand managing appropriate treatment.Hyperbaric medicine is moreof an ongoing treatment in a very differenttype of population to the divers. Bothareas are quite different to the practiceof anaesthesia. One area of relevance toanaesthesia is in the acute managementof divers, which may involve a complexretrieval process and often anaesthetistsor critical care practitioners are wellversed in retrieval issues.MW: The bulk of our patients havechronic wounds or radiation injuriesthat we’re treating, and a lot of them aremedically quite unwell. Anaesthetists havethe skill of being able to assess people’smedial conditions and make sure that theyare stable and everything’s optimised asfar as medical treatment is concerned,and we can then anticipate their responseto increased atmospheric pressure andgas density. It’s similar to a preoperativeassessment. With respect to Ian’s previouscomment about intensive care patients,there are some units that treat a lot ofintubated ventilated patients. For example,at the Alfred Hospital in Melbourne theyare running some special trauma researchprojects where they actually have a lotof critically ill ICU patients treated intheir chamber. Their chamber is locatednext door to the ICU, and they utilisetheir ICU and anaesthetic registrars quitesignificantly to run the hyperbaric unit.DC: The Alfred would probably be anexception to that rule. Certainly here inHobart I’m the only intensive care specialistin town with an interest in diving andhyperbaric medicine. There’s a moderateamount of further education necessary forme to convince some of my ICU colleaguesof the potential for benefit from hyperbaricoxygen treatment.What opportunity is there forresearch or completing formal projects?DC: There are loads of opportunities; thething that we lack is the time and the moneyto do it. This is a field of medicine that lendsitself to research. There are huge numbersof unanswered questions regardingeverything from basic physiology to cellularbehaviour under hyperbaric conditions.Unfortunately most hyperbaric units arerunning on very small numbers of FTEs sopeople have significant other calls on theirtime which prevent them from doing thissort of research. Also, because hyperbaricoxygen as a drug isn’t patentable, there’svery little industry sponsorship availableto fund these big trials. Although there islots of potential for research there are just acouple of small limiting factors that getin the way at the moment.MW: Having said that, all of ourregistrars have easily been able to completetheir formal projects in their six-monthattachments. There are lots of opportunitiesfor research. There are many internationaltrials running at the moment which it ispossible to join. There’s a lot of theoreticalphysiological work also. One of our localrespiratory physicians is very interestedin using our chamber to look at cellularbehaviour in cystic fibrosis, for example.There are lots of non-hyperbaric medicineapplications available for research andcertainly it’s one of the big areas where a lotof research is currently being done.IM: I would add there is a greatopportunity for anaesthetic registrars tocomplete their formal project requirementfor anaesthetic training. The Diving andHyperbaric Medicine journal of the SouthPacific Underwater Medical Society ishopefully going to be indexed on Medlinevery soon, so a publication in that journalcould be considered for the anaestheticformal project.Has training in diving and hyperbaricmedicine affected your progress inanaesthesia training?IM: I suppose the main issue is timeaway from anaesthetics and practicallygiving anaesthetics. My experience isthat one seems to deskill in anaesthesiaas a trainee very, very quickly so I’m a bitworried about returning to anaesthetics.However, this unit is good in that we gettime off to attend anaesthetic tutorials orto attend theatre during the week. So theremay be a period of deskilling but I think theoverall benefits outweigh that.MW: It’s probably no different to doinga term in emergency medicine or even goingto ICU for a term as far as maintainingclinical anaesthesia skills goes.DC: Likewise with pain medicine.MW: You’re still exposed to patients andyou’re still doing clinical work, you’re justnot actually in theatre putting people off tosleep and waking them up. Although it’s abit of a break away from anaesthesia, I don’tthink it impedes your progress in training.I think it’s just another one of thoseoptional rotational turns that can giveyou a bit of a broader education.DC: I certainly think the majority oftrainees in diving and hyperbaric medicinethat I have seen come through this unitor have met elsewhere have been welladvanced in their training programs. Inmany cases they’re doing it post-part twoexamination and they work it into theirtraining as an elective-type term in theirfellowship. Certainly when I did my firstregistrar rotation here, which was sixmonths, I already had both the intensivecare fellowship and the anaesthetic parttwo examination and I think a lot of othertrainees fit a similar pattern.Has exposure to diving andhyperbaric medicine affected yourfuture career pathway?IM: Okay, well I’ll start with that, beingthe most junior here. This exposure hasgiven me further interest in the area and itmay well be that I attempt to do some divingand hyperbaric medicine as a consultant.38The ANZCA Bulletin June 2009

DC: As someone who’s slightly furtheralong his career path, I would hope that itwould give me the opportunity to move intodiving and hyperbaric medicine on a morepermanent sort of basis. The difficulty is,of course, that there’s only a small numberof chambers around the country, so fulltime positions in diving and hyperbaricmedicine are a rare commodity indeed.Most of the time you are left with thedifficulty of having a part-time commitmentto hyperbaric medicine and also workingpart-time in another department. Workingacross a couple of departments can lead topotential conflict in terms of rostering andrequirements between the departments.I would very much like to do morehyperbaric medicine.MW: From my point of view, I’ve beendoing hyperbaric medicine since 1989when I started as a very junior registrar. Inow work primarily in private anaestheticpractice and I come to the public hospitalone day a week and do hyperbaricmedicine. It’s quite nice to have contactwith the public sector – a change in paceand a chance to do some research, which isnot really possible in private practice. Fromthat point of view it’s fitted quite well intomy career path.Most of the consultants who work parttimein our unit are working here one daya week or one day a fortnight. We havea number of people on our roster so wehave a pool of people with expertise whocome in on a rostered basis. That meansthat everyone keeps their skills up andkeeps their interest level going, has anopportunity to be involved in researchprojects, and can cover for after hoursemergencies so it works quite well.How have you found the overalltraining, and do you have anysuggestions for improvement in trainingin diving and hyperbaric medicine?IM: So far I’ve enjoyed the training andI’ve got a great deal out of it. The researchopportunity as mentioned has been veryuseful for me. I’ve also had the opportunityto go on courses and the recent SouthPacific Underwater Medicine Societyconference. So far, two-thirds of my waythrough, I’ve found it very interesting andvery useful. I think it may be a little bit earlyfor me to suggest improvements.DC: As somebody that’s still jumpingthrough the hoops of the training program,I think the training itself is good fun – it’sinteresting, intellectually stimulatingand offers a large range of opportunitiesfor people to sort of grow and develop aseither clinicians or researchers. The majordownside that I have found, however,has been doing it part-time. I’m now nineyears post-fellowship and I’m coming upto doing another college examination as amoderately experienced consultant and it’shard to get back into the mindset and grindof examination preparation. I think thatthe part-time training has the potential tobe a disincentive to future trainees doingthe College certificate. I would recommendthat if people are intent upon doing theCollege certificate that they try and get itdone in a much shorter period of time thanI have taken over it. But that will, of course,depend on the availability of FTEs on thepayroll of the various units.MW: Although I received my certificateas a “grandfather”, I did have to show thatI had satisfied the requirements and ithad also taken me about five years to getthe required number of FTEs up doing itpart-time. I think the major thing with anytraining program is the patient case loadand depending on which unit you work inyou may be exposed to a large number ofpatients with a certain condition but not somuch of another. In our unit there’s a lotof exposure to wound care and radiationinjury and not so much exposure to divinginjury because at the moment we seem tohave our divers behaving themselves andnot getting injured. On the other hand, inTownsville they treat a large number ofscuba divers in their unit, due to the largenumber of divers on the reef. If you were togo to the Alfred you’d get to look after a lotof patients that are intubated and ventilatedso it really depends on where you’re doingyour training as to what kind of exposureyou get.IM: A formal rotation around thedifferent units may be of benefit.MW: I would suggest an attachment toanother unit which has a different kindof case load so you can get to see somedifferent sorts of patients. At the momentthat’s all still evolving, and we’re stillaccrediting units for the entire periodof training, because it doesn’t seem tobe a practical problem at the moment.Above: Dr Ian Maddox in the chamber.The ANZCA Bulletin June 2009 39

advertisement40The ANZCA Bulletin June 2009

profileDr Vanessa Beavis:From South Africato New ZealandDr Vanessa Beavis divides her time betweenbeing the director of Anaesthesia andOperating Rooms at Auckland City Hospital,the largest hospital in New Zealand, andher role as chair of the ANZCA New ZealandCommittee. She has been a member of thecommittee for six years, the last as thechair. She is also a Part II examiner, wasthe founding chair of the Anaesthetists inManagement special interest group and isa member of the Perioperative MedicineCommittee. Recently, Dr Beavis was thechair of the ANZCA New Zealand panel forvocational registration for three years andin this capacity has also been a memberof the College’s International MedicalGraduate Specialist (IMGS) Committee.In addition, she is also an honorarysenior lecturer at the Department ofAnaesthesiology at Auckland University.It is a dramatic change from her earlyworking life as a doctor in her native SouthAfrica. “The first day I started work as adoctor was on New Year’s Day at a very bighospital on the East Rand,” she said. “Asyou can imagine it was enormously busy.On that first day I did not know how to putin an intercostal drain and by the end of thenight I had put in 24.”There are many differences in themedical experiences and training betweenSouth Africa and her adopted home of NewZealand including that general practitionersare allowed to give anaesthetics. The EastRand hospital delivered more than 100babies a day and Dr Beavis was taught howto perform an epidural by the obstetriciangynaecologist.It was the first anaestheticshe administered.Those experiences triggered a greaterconnection with the specialty. “Withanaesthesia, you have very broad exposureto lots of different things. I like the basicscience associated with anaesthesia, I lovephysics and the way machinery works – it isjust so entirely logical.”In the South African system trainees arerequired to pay their own costs, includingtraining fees. As a result, most doctorsneed to supplement their income. Dr Beavisbecame involved in medical evacuations.“I worked for a private insurancecompany that ran a mobile intensive caresystem for people with insurance, such asdiplomats,” she said. Dr Beavis said shewas involved in more than a dozen medicalevacuations all over Africa.“You learn to make do with very littleand to use all your ingenuity,” she said. “Itwas absolutely terrifying but it could alsobe great fun. There was always a doctor andone or two nurses, depending on who youwere going to retrieve, as well as one or twopilots. We would carry American dollars incash, depending on where we were going,so that, for example, you could bribe yourway out of the airport in the middle ofthe night.“One night we went to a central Africancountry where there had been a near-death.The whole plane was full of beer as that wasthe currency. Another time we were flyingin the middle of the night when a powerfulpolitician was trying to move gold bullionto a Swiss bank. As we landed, the planewas surrounded by soldiers with guns.They thought we had arrived to steal thegold. Luckily, we managed to get ourselvesand our patients out safely.”Dr Beavis finished anaesthesia trainingin South Africa in 1993 and arrived at theDepartment of Critical Care Medicine atAuckland Hospital in New Zealand in 1994.She said her family decided to migrate forpersonal safety reasons and because theydid not want their children growing up inthat environment.There were some initial challengesfor Dr Beavis, coming from an Africanhealth system with a mix of first worldsophistication and third world pathology,to one where the ordinary run-of-the-millpublic system provides the best careavailable.In 1997, when New Zealand was settingup its liver transplant program, Dr Beavisspent three months at the Mayo Clinic inRochester, Minnesota learning how to doliver transplants. “Lots of people haveworked overseas but this was different,”she said. “We were setting up a brand newnational program deliberately targeted forlivers and looking at systems and processesfor that express purpose, as opposed to justgaining clinical experience.”Dr Beavis was appointed deputy clinicaldirector at Auckland Hospital shortly afterreturning from the Mayo Clinic and thenclinical director of the department twoyears after that. She was then appointeddirector of Anaesthesia and OperatingRooms and was responsible for integratingfive anaesthetic departments into one in2003 when the hospital relocated to itscurrent premises.Along the way, Dr Beavis started to takemore and more interest in the professionalside of anaesthesia: “I know it soundstrite but I felt I had been offered so manyopportunities and had been given so muchthat I really did need to give somethingback. Fortunately in those days you wereallowed to become a Fellow by election.”She was subsequently elected to theNew Zealand national committee. Asa member of the International MedicalGraduate Committee she conducts IMGinterviews and assessments in New Zealandand Australia. She is also involved withhospital inspections and was a memberof the Perioperative Medicine TaskforceCommittee and the working group thatpreceded it.Dr Beavis said that part of the attractionof doing work with the College was thatyou worked with smart people who werevery committed. “The College work isvery satisfying professionally. Everylarge organisation has a certain amountof bureaucracy but you have to, or elseyou just have chaos. I am trying not to letanybody find out that I am really enjoyingmyself quite a lot.”The ANZCA Bulletin June 2009 41

PROFILEDr Tony Richards:Anaesthesiain the fast laneDr Tony Richards is a 47-year-old paediatricanaesthetist from Christchurch. He is NewZealand born, bred and trained, apart fromstints in London and Melbourne. “I’ve spentmost of my medical years, since my clinicalyears as a medical student, at ChristchurchHospital culminating in being head ofpaediatric anaesthesia. I’ve been privilegedto have a career in paediatric anaesthesiaand have always enjoyed and been humbledby the challenge of working with childrenand helping them through their time ofneed,” he said.Dr Richards said that anaesthesia is awonderful career with many opportunitiesand he intends to explore a few more in theremainder of his career, including takingsome more time off with his wife and family.“Eventually we would like to take ourcareers overseas, splitting time betweentravel, work and charity work. As keenskiers we’d expect to be fitting a wholelot of that in as well!” he said.Ever since Dr Richards can remember hehas wanted to be involved in motor racing:“I think back to my father taking me to racemeetings at Levin and Manfield in the ’70sand watching the cars that I was actuallylater to race against, and loving the wholespectacle. I’d always wanted to give it a go,but never did, or not until a recent majorlife crisis led me to revaluate, get off mybackside and ‘tick a few boxes’.”F5000 was introduced as a V8 stockblockclass in the late ’60s as an alternativeto F1 and quickly swept the world. InNew Zealand and Australia it became“The Tasman Series” and was contestedby some of the world’s best-known drivers.Dr Richards said: “I’m a committee memberof the NZ F5000 Association and in the lastfew years we have been at the forefront ofthe re emergence of this historic class frommy childhood. With a nucleus of more than30 cars plus overseas support we regularlyput together competitive internationalgrids of 25-plus cars around Australasia inThe Tasman Revival Series.”He said the experience of racing the320kmph cars is difficult to describe: “Witharound 550bhp and no driver aids, these oldbeasts are raw but very rewarding to drive.The consummate race car. They are loudand brash and assault all of your senses.The crowds love them. It’s simply the bestthing I’ve ever done. The series is attractinga lot of attention and this finally led to aninvitation to be a support race class at theF1GP in Melbourne, 2009. It was an honourto take these cars back to the AustralianGP which they last raced at 30 years ago. Imanaged to finish second in our series, beatCraig Lowndes’ new V8 Supercar lap recordat Albert Park, to break our lap record, andspray French champagne from the top of theF1 podium in what, for me, was a great day.A boyhood dream come true.”Clockwise from top left: Dr TonyRichards getting ready to race; DrRichards gets the chequered flag;Dr Richards, second from the right,celebrates on the podium.42The ANZCA Bulletin June 2009

philanthropyThe ANZCA FoundationAn initiative of the Australian and New ZealandCollege of AnaesthetistsYvonne Kenny visitsthe Kolling Instituteof Medical ResearchRecently the chairman of the ANZCAFoundation, Professor Michael Cousinshosted a visit by Yvonne Kenny, one ofAustralia’s great opera divas, to the PainManagement Research Institute at RoyalNorth Shore Hospital, Sydney. Ms Kennyis a member of the ANZCA FoundationBoard and this visit provided an excellentopportunity to view the new researchfacilities at the Kolling Institute ofMedical Research.This visit was also an opportunity tothank and present Ms Kenny with a copyof the Foundation’s recently completedaudio/visual presentation highlighting therole of Fellows and anaesthesia to a wideraudience in Australia and New Zealand. MsKenny very kindly permitted a recordingof her performance of “I dreamt I dweltin marble halls” to be featured as thebackground to the presentation. Thereare plans for this presentation to alsobe shown on the ANZCA Foundationwebsite in coming months.Top, from left:Professor Michael Cousins, ANZCAFoundation chairman with board memberYvonne Kenny;New board members John Astbury andGeoffrey Linton;Foundation board member Yvonne Kennymeets researchers at the Kolling Institute.New appointmentsto The ANZCAFoundation BoardTwo new appointments have been madeto the Board.John AstburyMr Astbury has a long history in seniorbanking and finance positions in theUK and Australia. He is a director ofWoolworths Limited and a Fellow of theAustralian Institute of Company Directors.Geoffrey LintonMr Linton has wide business experience,being a former partner at Ernst & Young.He is presently the secretary of the CollierCharitable Trust in Victoria. Geoff isa Fellow of the Institute of CharteredAccountants in Australia.The ANZCA FoundationPatrons ProgramThe ANZCA Foundation Patrons Programwill be progressively introduced to Fellowsand the wider community over the comingmonths. The Patrons Program has beenestablished to encourage and recognizethose people who wish to support medicalresearch and education. All donationswill be solely directed towards medicalresearch and education with the Councilof ANZCA determining the awarding of thegrants. For further information concerningthe Patrons Program, please contact IanHiggins on +61 3 9093 4900 or via emailihiggins@anzca.edu.auThe ANZCA FoundationBequest ProgramA bequest to the ANZCA Foundationwill greatly enhance ANZCA’s ability toundertake important medical research thatwill significantly improve outcomes for thehealth of future generations.You might consider a bequest to theANZCA Foundation whether as a specificamount of money, a proportion of yourestate, the residual of your estate or otherspecific property.Your will and financial planning areintensely personal, and the Foundationrespects your privacy. However, if you wishto allocate an amount to the Foundation,or to honour or commemorate a namedindividual, the staff at the Foundation arereadily available to provide assistance. Alldiscussions will, of course, be confidential.We strongly recommend that you seekprofessional advice regarding your will.A solicitor will help you make a clear,concise will, which is easily located andcauses no misunderstanding.For all inquiries please contact:Ian HigginsDirector, The ANZCA FoundationANZCA House630 St Kilda RoadMelbourne VIC 3004Tel: +61 3 9093 4900Fax: +61 3 9510 6931Email: ihiggins@anzca.edu.auThe ANZCA Bulletin June 2009 43

advertisementABSTRACT SUBMISSION NOW OPENwww.willorganise.com.au/spanza2009CALL FOR ABSTRACTSThe Organising Committee is pleased to invite submissions ofabstracts to be presented at the 2009 SPANZA Conference.Presentations may either be submitted as an oral presentationor a poster. All abstracts must be submitted online.Closes: 8th SeptemberREGISTRATIONRegistration is now available online.You can also download a hard copy of the registration brochurefrom the home page of the website or contact the conferencesecretariat to obtain a copy of the brochure.Society for Paediatric Anaesthesia inNew Zealand and AustraliaCONFERENCE SECRETARIAT: PO Box 180, Morisset NSW 2264, Australia • Tel: 02 4973 6573 Fax: 02 4973 6609Email: spanza2009@willorganise.com.au • Website: www.willorganise.com.au/spanza2009The Rural Special Interest Group2nd Annual Meeting‘Gumnuts and Joeys’Delivering Anaesthesia in the BushCrowne Plaza, Hunter Valley23 - 25 July 2009For further information contact:Marta DziedzickiSpecial Interest Group Coordinator630 St Kilda Road, Melbourne VIC 3004Telephone: (+61 3) 9510 6299Email: mdziedzicki@anzca.edu.auWeb: www.anzca.edu.au/fellows/sig/rural-sig/2009-rural-sig-conference44The ANZCA Bulletin June 2009

advertisementRoyal Melbourne HospitalDepartment of Anaesthesiaand Pain ManagementAnnualRefresherCourseTheme: Anaesthesia and Co-Existing Disease,Stents, Statins, Steroids and more…How common medical conditions impacton the management of anaesthesiaVenue: Royal Melbourne HospitalDate: Friday 30th October 2009For further information please contact:Dr David MooreDr May LimCourse ConvenersTel (+61 3) 93427540Fax (+61 3) 93428623E-mail d.moore@mh.org.au4th International HokkaidoTrauma ConferenceadvertisementRusutsu Ski Resort, JapanJanuary 17th-22nd 2010Topics include:- Airway Trauma- Pre-hospital controversies- Trauma in obstetric and paediatric patients- Integrated interventional radiology theatresEarly bird registrations now open until 16th AugustFurther information, brochure, registration formwww.hokkaidotrauma.comThe ANZCA Bulletin June 2009 45

Quality & SafetyAustralian Commissionon Safety and Qualityin Health Care –Medical DevicesIncidents WorkshopMeeting highlightsThe aim of this workshop, held on March29, 2009, was to improve the sharing ofincident information nationally and tobetter understand medical device safety,both in design and technical complianceand in the evaluation of the role ofhuman factors and training in minimisingincidents with medical devices. Participantsincluded government representativesof health services, clinicians, nurses,quality assurance managers and industryrepresentatives. Among the clinicians,anaesthetists were well represented.Need for better reportingThe keynote speaker was Dr Larry Kelly,head of Office of Devices, TherapeuticGoods Administration (TGA) who reportedon the TGA Medical Device IncidentReporting Investigation Scheme (IRIS).The role of TGA is to regulate and monitorthe supply and manufacturing controls ofmedical devices and drugs and to evaluateadverse events associated with the use ormisuse of a medical device. It is mandatoryfor a manufacturer to forward any detailsof reports it has received on a device thatdid or could have resulted in an adverseevent. TGA has considerable regulatoryauthority to investigate all such reports andif necessary to mandate a recall. However,there is no such control on users as there isno obligation to report. Thus, an importantissue is the under-reporting of problemseither to TGA or the supplier.Dr Kelly presented figures for the 1317reports considered in 2008. Suppliersissued 1090 reports whereas hospitals,clinicians and nurses contributed only 190.The responses by TGA to the 1317 reportsreceived in 2008 indicated 20 recalls and30 alerts while improvement in design anduser education were a major outcomein a further 160 instances.The take-home message was that thereis urgent need for better reporting by userseither through the suppliers or directlyto TGA.Need for better designs and systemsA biomedical approach to medical deviceincidents was presented by Mr PatrickO’Meley, Area Director, BiomedicalEngineering, Sydney South West AreaHealth. He believes that incidentmanagement is poorly managed withinadequate documentation and that currentpractices are not solving problems.While falls, drug errors and diagnosticerrors in hospitals are now welldocumented, reports on equipment failureare “buried”. There is an assumptionamongst users that modern devices aresafe, yet there is often a lack of experience,poor choice in selection and inadequateeducation or foresight. To date, the mainfocus has been on electrical safety andother factors overlooked are multiplicityof devices, a design which overlooks theusage environment, and the possibility offatal configuration or user mistakes thatare difficult to eliminate. Other problemsinclude outmoded standards, poor serviceand support, while human factors areoverwork, distraction, increased complexityof devices and overload of information.Mr O’Meley’s message was the need forbetter designs and systems along with thedevelopment of best practice guidelinesfor configuration and selection.Pump infusion errorsIn a paper on pump infusion errors,Dr John Lambert, FANZCA, FJFICM,Director of Critical Care, Orange HospitalNSW suggested there was an increasingawareness that TGA approval is not the onlyrequirement for safe equipment choice asapproval may not meet reasonable clinicalstandards or expectations.With regard to infusion pumps there isa wide variety of designs on offer withdramatically different form factors anduser interfaces and many designs are notimmediately intuitive. In addition, thereis considerable variety in technologicalawareness by what is a relatively smallgroup of users, mainly nurses and doctors.Examples of the ability of clinicians to“innovate” at the bedside include the abilityto creatively bypass safety mechanismsand restrictions built into devices, thewillingness to use devices with nounderstanding of how they work and theability to justify the purchase of expensiveequipment as mandatory with limitedevidence of the benefit of such equipment.In a search of international data for pumperrors using free text, the reports wereclassified as medication incidents, medicaldevices and clinical management. Theoutstanding issue was pump setting errorswith less frequent reports of syringe/drug/fluid mix-up, errors in the use of infusiondevices or order error. Surprisingly, therewere free running line errors despitea “forcing function”. About 10-15% ofincidents involved the use of the wrongchannel on multi-channel devices, wrongpumps with multiple pumps in use and linemix-ups with lines swapped, mislabeled ornot tracked correctly.Of real concern was that the majority ofthese errors occurred in intensive care units.Suggestions for improvement includedavoidance of multi-channel devices,standardisation of devices to minimize userinterface difference errors, consideration ofthe use of unique devices for particularlydangerous infusions such as inotropes,epidurals, PCAs and possibly chemotherapyand the use of a forcing function for doublecheck when changing settings or lines.Case reportsOther case reports included the very fullinvestigation by Queensland Health onadverse events with PICC lines (wherethe outcome of ongoing discussions withTGA and the manufacturers are pending),the safety of endoscopic vascular repairof aortic aneurysms and incidents withpleurocaths.Of particular interest was a presentationfrom Stella Robinson of South AustraliaHealth on hospital bed safety. Overseas datapresented indicated that bed entrapmentwas a significant cause of mortality in theelderly. A state-wide audit of hospital bedsin South Australia revealed that 84% ofbeds in that state presented a variety ofentrapment hazards, importantly includingundersized mattresses, presumablyintroduced for reasons of economy.We now await initiatives that may followthis workshop.Dr Patricia MackayVictoria46The ANZCA Bulletin June 2009

Trauma, surgery,obstetrics and bleedingdisordersAnaesthetists and intensivists usuallyhave good access to blood and the bloodproducts they most commonly use and to aready source of advice from a haematologistor blood transfusion service whenuncommon issues arise.A previous article in the Bulletin (March2009) summarized the National BloodSupply Contingency Plan 2008. Newlyreleased is information relevant to the careof patients known, or suspected to have ableeding disorder and who suffer trauma,require surgery or are pregnant.The technical information comes with theauthority of the National Blood Authority(NBA) Australia, the Australian BleedingDisorders Registry (ABDR), the AustralianHaemophilia Centre Directors’ Organisation(AHCDO), the Haemophilia FoundationAustralia and all Australian governments.Websites include www.nba.gov.au; www.haemophilia.org.au and www.ahcdo.org.au.At this last website, under “publications”are “Surgery guidelines” and “Guidelinesfor the Management of Pregnancy”.Information provided by the ABDR includesa list of the different types of bleedingdisorders (36 in all), the usual “trigger” fordiagnosis (including trauma and surgery),the treatment regimen (on demand,prophylaxis, tolerisation and secondaryprophylaxis) and the products available,including suppliers.Patient details registered with the ABDRwill be entered into a database aimed atproviding accurate information to theauthorities tasked with ensuring thatagents used for patient care are availablein Australia in quantities sufficient fordemand. This information is not currentlyaccurate, which is why the registry isbeing revitalized.While Fresh Frozen Plasma (FFP),cryoprecipitate, platelets, DDAVP andTranexamic Acid are available generally,patients with specific bleeding disordersmust be registered on the ABDR inorder to be treated with the morespecialised products.As an aside, anyone wanting to use thisarticle as a stimulus for a CPD project couldinvestigate the latest information to befound on FFP, cryoprecipitate and plateletsthrough to more exotic products and theiruse for an increasing variety of bleedingdisorders, now including nine varieties ofvon Willebrand’s disease. Just a thought.Prof Garry PhillipsSouth AustraliaAudible oximeter tonesand alarmsIn 2008 ANZCA revised ProfessionalStandard 18, Recommendations onMonitoring during Anaesthesia 1 . Thisstandard now requires having an audiblevariable pulse tone from the oximeter. Italso requires an audible low limit alarm.“…the variable pulse tone as well as the lowthreshold alarm shall be appropriately setand audible to the practitioner responsiblefor the anaesthesia.”Correctly used monitoring tones and alarmspromote safety for our patients. Monitorsettings need to be checked at the beginningof a list and whenever there is a changeof anaesthetist. Inappropriate use ofmonitors puts patients at grave riskof undetected hypoxia.The US Anesthesia Patient SafetyFoundation has documented three casesof death and profound brain damagein healthy ASA1 patients due to lack ofappropriate monitoring 2 . These casesare recommended reading for allanaesthetists.Dr Rod TaylerEditorial Advisory BoardQuality and Safety CommitteeANZCA1. www.anzca.edu.au/resources/professionaldocuments/professional-standards/ps18.html2. www.apsf.org/resource_center/newsletter/2004/winter/03turn_on.htmThe ANZCA Bulletin June 2009 47

Quality and SafetyContinuedAnaphylaxis toChlorhexidineIn a recent edition of the British Journalof Anaesthesia, Parkes et al provide areport on three cases of anaphylaxis tochlorhexidine 1 . In all three reports theanaphylactic reaction followed the use ofurethral lubricant in the operating theatreand the authors noted that there may bea delayed presentation of cardiovascularcollapse and skin manifestations whichin these cases occurred some time afteradmission to the recovery area.A number of early reports of anaphylaxis tochlorhexidine were reported in urologicaljournals and two reports in Anaesthesia andIntensive Care in 1994 2 and 1995 3 all relatedto the use of urethral lubricants.Of interest is a case report which concerns amale undergoing a neck dissection and freeflap who developed marked hypotensionand tachycardia one hour after induction.A urinary catheter was being inserted atthe time and latex allergy was consideredbut proved negative. The patient made anuneventful recovery and skin testing wasunremarkable. The possibility of sensitivityto chlorhexidine was not considered atthis time.One year later the patient developed anerythematous rash over his entire bodyduring the insertion of intra-arterialand central venous lines (PICC line). Noanaesthetic drugs had been administeredbut the surgery did not proceed. Skin testingrevealed strongly positive reactions to boththe lignocaine-chlorhexidine lubricant usedfor the urinary catheter insertion and forthe subsequent use of chlorhexidine skinpreparation for the invasive monitoring.Anaesthetists are reminded that whenthere is unexplained cardiovascularcollapse, especially in the recovery area,the possibility of anaphylactic reactionsto chlorhexidine should be considered aschlorhexidine is present in a wide varietyof agents used in healthcare as well as inthe community.References1. Parkes AW, Harper N, HerwadkarA, Pumphrey R Anaphylaxis to thechlorhexidine component of Instillagel: acase series. Br J Anaesth 2009; 102: 65-682. Russ BR, Maddem PJ. Anaphylacticreaction to chlorhexidine in urinarycatheter lubricant. Anaesth IntensiveCare 1994; 22611-23. Parker F, Foran S. Chlorhexidine catheterlubricant anaphylaxis. Anaesth IntensiveCare 1995; 23:126Dr Fred RosewarneVictoriaQuality and SafetyCommittee membershipThe Quality and Safety Committee is justone of 12 committees of ANZCA that reportsto the ANZCA Council. While both myselfand Dr Elizabeth Feeney, President, ASA,are observers at the College Council, weare full members of the Quality and SafetyCommittee and therefore have an activerole on this important group.This means that opinions from outsidea direct college framework that reflectthe views of the respective societies’memberships can be expressed andparticularly from the NZSA point of viewthere is an additional New Zealand voiceon the committee. Not all practisinganaesthetists are Fellows but via this forumit is possible for them to have a say in theCollege’s activities.The committee is responsible for advisingand informing Council in matters of bothquality assurance and safety and also reportissues of concern directly to ANZCA fellowsvia the Bulletin or the website, giving allpractising anaesthetists up-to-date andtimely information that may seriously affectpractice. The discussions of the committeeare wide ranging and encompass all aspectsof quality and safety in anaesthesia suchas the Australia and New Zealand TripartiteAnaesthetic Data Committee process andthe preparation of appropriate guidelines.It is an interesting and enjoyable committeeto take part in, and its work is veryimportant for the patients of New Zealandand Australia.Dr Andrew Warmington, President,New Zealand Society of Anaesthetists (NZSA)Auckland, New Zealand48The ANZCA Bulletin June 2009

Changes to medicaloxygen connections– re-visitedThe March 2009 edition of the ANZCABulletin published an article by ProfessorJohn Russell regarding the recentamendment to AS2473.3 and the subsequentupcoming changes to medical oxygenconnections which are to be converted byall suppliers on a state-by-state basis overthe next two years.The College has received correspondencefrom the Australia and New ZealandIndustrial Gas Association (ANZIGA),regarding the schedule, and the informationis outlined opposite.Important changes to medical gas cylindersANZIGA recently wrote to you in regard to two important changes that are goingto occur to medical gas cylinders in the near future:• The changes to medical oxygen valve outlets as required by Australian StandardAS2473.3; and• The requirement that all medical gas cylinders have a white body with thecolour on the shoulder indicating the type of gasThis letter is to remind you that all large medical oxygen cylinders (D, E and G sizesincluding bundles/packs) will be supplied with a different valve outlet, called a pinindexed valve outlet, and will also be coloured white from the time indicated below:DateSeptember 2009February 2010May 2010August 2010February 2011June 2011LocationNorthern TerritorySouth AustraliaWestern AustraliaQueenslandNew South Wales/ACTVictoria/TasmaniaThis means that in your state or territory, from the date indicated above, large medicalcylinders will be available only with pin index valves. For example in NorthernTerritory from September 2009, large medial cylinders will only besupplied with pin index valves.Prior to the changeover time in your state or territory, you will need to arrange fora replacement medical oxygen regulator in order to be able to connect to the newvalve outlet. It is recommended you contact your regulator supplier or medicalgas supplier for assistance with your requirements. Users of medical oxygen withmanifold systems will need to have their manifold connections and/or flexibleconnections changed prior to the change-over date.Please contact ANZIGA or your medical gas suppler if you require further information, at:ANZIGALevel 1, Unit 7, Skipping Girl Place651 Victoria St, Abbotsford, Vic 3067Telephone: +61 3 9426 3812Email: office@anziga.orgThe ANZCA Bulletin June 2009 49

fellowship affairsSuccessfulcandidates2009Primary FellowshipExaminationThe written section of the examination washeld on March 2 and the viva examinationwas held from April 27-29.A total of 116 candidates successfullycompleted the Primary FellowshipExamination and are listed below:Freya Emily AaskovLahiru Nipun AmaratungeSophie Jane AndersonCatherine Marie AshesPeter Joseph BainbridgeMichael Lee BassettMiles Christopher Charles BeenyPaul Joseph BennettEstibaliz ArantzazuBlazquez BasarrateDaniel Edward BoydJeremy Luke BrammerAlastair BrowneTimothy James ByrneRodney James CansdellGeoffrey Paul CardenBenjamin CeruttiRani ChahalKah Lynn Elene ChanIan Thomas ChaoChong Yee HuiAnne Wai Li ChewDaniel Martin ClarkeBenjamin Andrew CrookeAndrew DeaconEdward Michael DebenhamRachel DilerniaAndrew John DonohueTrung Thien DuRosemary Kaye DuckettDaniel William EllyardJeremy David FieldStephanie Wei Yin FongAndrew Beresford FosterMichelle Diana GerstmanQLDVICTASNSWVICVICVICQLDNZNZQLDNSWVICQLDNZQLDVICQLDVICNSWVICQLDQLDNSWWAVICNSWVICNZWANSWNSWSAVICDr Yahya Shehabi (left), retiring PrimaryExaminer and Dr Craig Noonan, Chair,Primary ExaminationBenjamin Thomas Hayes GreenwoodAlex GrossoArvinder GroverPaul Christopher HalesMichelle HarrisDaniel Alexander HartwellDavid HarveyPaul Mark HealeyNicholas Peter HeardMarsha Kim HeusVui Kian HoAndrew Stewart HuntBrendan Alexander IrvineVeerendra JagarlamudiDinuk Arshana JayamanneMelissa JohnstonGeorge William KennedySaejin KimBenn Morrie LancmanHarvey Hsin-Fu LeeDaniel Mattathiah LevineLim Guan Cheng JimmyLim Wei Ming WilfredLing Wai YipJamahal Maeng-Ho LuxfordHamish Stuart MaceMak Wai YinMak On Li AnnMak Nok LeiClare Bronwyn McArthurNZQLDVICVICVICNZNZNSWQLDNZSGPWANSWNSWACTNSWQLDVICNSWVICNZSGPSGPHKGVICWAHKGHKGSGPTASRobert David MiskeljinSteven James MitchellNurul Shamsidar Mohamed BakriWendy Julia MorrisPremala NadarajahArjun NagendraOriana NgChong Seng OngOr Yin LingSamarasimha PandhemAnand ParameswaranPavithra PasupathySze Ying PuiJoshua Simon RathLloyd Antony RobertsEmma Louise RosenfeldElitza Vaneva SardarevaRyan George SavageBrett Elliott Fabian SegalSukhpreet Singh SihotaSancha Claire Simpson-DavisAlexander J SmirkJessica Natalie SmithScott Anthony SmithEra SoukhinLouise Mary SpeedyDana StankoChristopher Charles StoneJeremy Thomas SuttonChandrashekhar TalekarAngela Helen TanTan Pei YuTze Ping TanCarradene TaylorJohn Yuk Ching TingClement Wei Ming TiongTse King Yan CatherineMichael Andrew TsiripillisTsui Sin Yui CindyChristopher Andrew TurnbullNeil VanzaHendrik Stephanus ViljoenQLDNZQLDQLDQLDNSWSGPVICHKGQLDQLDNSWHKGNSWVICNSWNZTASQLDNZQLDVICNSWQLDNZNZWANSWSANSWWASGPVICQLDNSWNSWHKGVICHKGQLDVICNZ50The ANZCA Bulletin June 2009

Wai Ka MingLaurent Anthony WallacePaul Christopher WilliamsDonna Leanne WillmotAndrew Norman Richard WingMichael John WirthNicola Ellen WoollardJia Jia YeYip Yu YeungNusrat ZahanHKGNSWNSWSANZSAQLDNSWHKGNSWRenton PrizeThe Court of Examiners recommended thatthe Renton Prize for the half year endedJune 30, 2009 be awarded to:Dr Alexander SmirkVICMerit CertificatesMerit Certificates were awarded to:Dr Catherine AshesNSWFinal FellowshipExamination(Anaesthesia)The written and medical clinical sectionof the examination was held on April 3-4and the viva examination was held fromMay 29-30.A total of 150 candidates successfullycompleted the Final FellowshipExamination and are listed below:Shalini AchuthanMahsa AdabiErik Steenfeldt AndersenTrevor Robert ArnoldSimon Antony AstegnoCeline BaberMichael BabonLiam Patrick BalkinRavi BangiaVICVICNZNSWVICWAQLDQLDVICFinal Examination Court of ExaminersBrendon Eric BuzacottWayne CarstensChan On YiChan Lai MeiJune Mei Yee ChanJanette Yuk Sau ChanGiresh ChandranArthur Yin Sau CheungSue Cheng ChewTarragon MacLeod ChisholmChu Ka LaiMatthew John CoadyAdriano Gino CoccianteErica Jane Dibb-FullerGavin DoolanScott James DouglasWayne Paul EdwardsPeter James EffeneyQLDSAHKHKNSWVICSAVICVICNZHKGNSWVICNZVICSAQLDVICDr Daniel BoydNZHannah Mary BarkerVICCatherine Elizabeth EganSADr Daniel EllyardDr Andrew HuntDr Benjamin JonesDr Daniel LevineDr Lloyd RobertsDr Angela TanDr Andrew WingWAWANSWNZVICWANZAnthony John BarnardNicola BeauchampMichael Ryan BishopDane BlackfordMark Stephen BoeschChristopher Joseph Thureau BreenDeas Macdonald BrouwerDavid James BurtonSAQLDQLDACTNSWQLDVICNZDavid Geoffrey FaheyNasim FahimianJeremy Ranil FernandoPeter Julian FlynnCatherine Maree FullerTu Quyen Therese FungAlexander Hugh Degaris GaleAlexander GershenzonQLDWANZACTWAVICACTVICThe ANZCA Bulletin June 2009 51

fellowship affairsSuccessfulcandidates2009ContinuedJonathan Rael GolshevskyVICGary NewfieldNSWSharon Lii-Anna TsetongNSWGregory Piers Timothy HackmanNSWAndrew Ng Wei AunMALKhai Tan VanQLDBenjamin HallettAngelique HallidayJames Anthony HallowayAdam Francis HastingsDean Rowan HaydonGeoffrey HealySarah Louise HedgesAlexandre Stephane HenryBradley Michael HindsonJames Allen HoskingRaymond Tiong Chin HuRomi JanovicJames Paul JarmanAndrew David JonesJonathan Howard KapulDebbie Margaret KnightSteven KohJames Michael KoziolVICWANSWNSWQLDNSWWAVICVICQLDVICVICVICVICQLDSANSWVICJoseph Yeuk-Kei NgShe Yin NgMerlin Edward NicholasToby Troup NicholsPanya NipatcharoenNjo Kui Hung AnthonyKim Alexander NuyenPallathu Kadavil HasherAndrew George PatersonMargo Joan PeartAndrew James PeartSabine PecherAdam David PerczukJennifer Anne PlummerPoon Ching Mei ClaraMark Vincent PorterAndrew Douglas PowellArvind Raju Ganga RajuWANSWWAWANSWHKVICNZNSWNSWNSWNZNSWVICHKNSWNSWNSWPaloma Gioia Van ZylRamesh VasoyaStefan WaeldeHelen Marie WardWat Chun YinEdith BodnarKim Yuh-Kuan WengTiffany Jane Candida WilkesLuke Anthony WilsonChun Keat WongZarina Wai Bink WongWong Sze MingWong Hoi Kay TiffanyGin Leong WongChristopher Kin-Bonn WongJordan Gardiner WoodDavid John WrightNSWNZVICNSWHKVICNSWQLDVICSANZHKHKWANSWNZACTOscar KwonNSWDerek Michael RosenNSWYeoh Hann Sean BrianMALDavid LamVICPaul Robert RoweNZAlexander Michael ZoszakNSWAndrew Kenneth LansdownSidney S Y LauDavid Guo Rong LawRowena Anne LawsonNSWWAWAACTGiles Victor SampsonBradley David SartoriShimon ScharfRajesh SethiNSWQLDVICSAThe Court of Examiners recommended thatthe Cecil Gray Prize for the half year endedJune 30, 2009 be awarded to:James Paul JarmanVICYue Peik LeongLi LinTing-Ting LiuGordon Joseph MarElmo Niroshan MariampillaiKate Ann MatthewsPaul Crossman McCallumNZVICNSWVICVICQLDVICAndrew William SmithAngela Ruth StephenMichael John StoneKarl Peter SturmSivanesan A/L T SubramaniamTamsin Melissa SuppleWai Yin TamNZNZNSWNSWMALVICVICMerit Certificates were awarded to:Jonathan Rael GolshevskyJames Michael KoziolDominique Bayu Anthony MullerMark Vincent PorterHelen Marie WardNSWVICWANSWNSWSarah Grace McLeodHamish Douglas Devenish MearesVICNSWRoger Cheng Wah TanChristine Ee Yean TanWAWAInternational Medical GraduateSpecialist Performance AssessmentAgnes Katalin MolnarElizabeth Mary Louise MoranAl MotavalliCatherine Marie MuggeridgeDominique Bayu Anthony MullerNSWNZVICACTWATang Mee YeeSelene Tang Wei LienMelanie Elizabeth ThewDamon Nicholas Simon ThompsonSamantha Marie TongMALVICWANZNSWA total of three candidates successfullycompleted the International MedicalGraduate Specialist PerformanceAssessment on Friday, May 29 andSaturday, May 30, 2009 and are listed below:Dr Robert BrinkmannQLDLuke John MurtaghSAJoshua David ToothQLDDr Alexander MacKinlayTASKirstin Larissa NaguitNSWAmelia TrainoNSWDr Anthony ParakkalVIC52The ANZCA Bulletin June 2009

ANZCACurriculum ReviewThe Why, Who, Where and HowWHY a Curriculum Review?The College has initiated a review of the ANZCA TrainingProgramme to ensure the curriculum remains contemporary,and that ANZCA Trainees are experiencing the highest qualityteaching and learning opportunities and achieving optimalclinical competence.WHO is conducting it?A Curriculum Review Working Group (CRWG) has beenappointed to oversee the review process and this groupreports directly to the Education and Training Committeeof ANZCA Council. Chairing of the CRWG and coordinationof the overall review process is the responsibility of theANZCA Education Development Unit (EDU).WHERE is it up to?The CRWG had their first meeting in August 2008, whereprinciples and plans for the review process were established.An open submissions process was then undertaken by theCRWG from October 2008 to January 2009 (inclusive), withinvitations sent to key stakeholders. The CRWG was pleasedto receive a total of 132 submissions from a range ofstakeholders, including ANZCA Committees, Fellows, Traineesand Staff. A diverse range of external stakeholders madesubmissions, including: other Colleges; anaestheticassociations; various government/regulatory bodies; aswell as other affiliated professional groups; and a numberof international experts in medical education. The secondmeeting of the CRWG was held in March 2009, whereanalysis of the submissions commenced.WHERE to next?The EDU is currently undertaking a full analysis of thesubmissions to produce a discussion document for the review.Later in 2009 this discussion document will be used to forma census-style survey of all ANZCA Fellows and Trainees.The results of the survey will then be used to produce a set ofagreed recommendations for the ANZCA Training Programme.HOW can I contribute?Later in the year all ANZCA Fellows and Trainees will beinvited to participate in the Curriculum Review Survey, sokeep your eye out for advertisements in this, and other ANZCApublications. The survey will represent another opportunity foryou to have your say about the future of the ANZCA TrainingProgramme, so we hope all Fellows and Trainees will be keento voice their opinion.HOW can I find out more?For a full summary and up-to-date information,visit the Curriculum Review Home-page:www.anzca.edu.au/edu/projects/curriculum-reviewFor further information, email the Curriculum ReviewCoordinator, Claire Byrne: cbyrne@anzca.edu.auThe ANZCA Bulletin June 2009 53

advertisement54The ANZCA Bulletin June 2009

advertisement142_ANT_Agilia_HP_Ad d4FA.indd 12/04/09 4:51 PMhealthdownsouthOtago + Southland District Health Boards New ZealandadvertisementA deliberate decisionAnaesthetistSouthland Hospital, Invercargill, New ZealandThere might be any number of reasons you make a deliberate decision to relocate- gaining experience that will take your career places, building a career that won’t seeyou pigeonholed professionally, looking for a lifestyle that offers more, for you and yourfamily or an adventure.Whatever the reason we’ll make you welcome. How does Southland Hospital differ tosome? Ours is a secondary level hospital rebuilt just five years ago. We’ve incredibly goodfacilities and equipment. We’re benefiting from a strong emphasis on clinical governance– our services and working relationships across the hospital are reflective of it.You’ll complement a well respected senior team of general anaesthetists. If you are aconsultant starting out you’ll be hard pressed to find a better environment in which toestablish a reputation. Or, as an experienced consultant you’ll find yourself with definitescope to balance the work you love with a life outside of it. The department is accreditedfor training so it is crucial you be eligible for vocational registration. You’re assured of theopportunity to combine private and public practice if you’d like to.A deliberate decision you think may benefit you? You’re welcome to contactJan Jenkins jan.jenkins@sdhb.co.nz or on +64 3 214 8261 for more information.Otherwise see the Big Careers Section of our website for application details.Little CountryGiant LifeBig Opportunitywww.healthdownsouth.co.nzANZCA Bulletin, June issue, deadline 29 MayThe ANZCA Bulletin June 2009 55

fellowship affairsCanMEDS CurriculumFrameworkThe CanMEDS Curriculum Framework– How will it change your life?Recently, I asked a group of anaestheticteachers what the CanMEDS Frameworkmeant to them. I wasn’t trying to trickanyone or show off my own knowledge. Igenuinely wanted to know. The responsethat greeted me was polite silence. Aftera while, one of them volunteered ‘Isn’t itthat list of things in the introduction of themodule book?’ That Fellow was right, ofcourse, but it is also the cornerstone of theANZCA curriculum framework and I hadan expectation that, as such, it should havean impact on the way in which our traineesand their teachers think about all theireducational activities.I have received very similar responses(indifference, bemusement, lack offamiliarity) from other groups of traineesand anaesthetic teachers to whom I havetalked about CanMEDS. Why should it bethe case that so few people know aboutCanMEDS or feel that it has an impact onthe ANZCA training program? CanMEDSwas adopted in 2004 as the curriculumframework for the ANZCA training program.At this stage it was used in its generic format.At its inaugural meeting in August 2008, theCurriculum Review Working Group (CRWG)agreed to use the CanMEDS-2005 frameworkfor the revised curriculum that will bedeveloped. During this curriculum reviewthe framework will be tailored specificallyto contemporary Australasian anaestheticpractice. (see http://www.anzca.edu.au/edu/projects/curriculum-review for furtherdetails of the CRWG).As a community, it is important thatwe develop a curriculum framework forour trainees that is widely understoodand useful in practice. The followingarticle, written by Dr Genevieve Goulding,helps to provide that understanding. Sheexplains the background to the framework,how and why it was developed and howit can be used locally. When the CRWGhas completed its work, I look forwardto sharing with Fellows and Trainees thedetail of our local CanMEDS framework.It is my sincere hope that, in the future,this will be helpful in shaping all teachingdelivered by ANZCA Fellows and learningreceived by ANZCA Trainees. So, whilst theCanMEDS framework may not change yourlife, we do hope that it will have a positiveimpact on your educational practiceand experience.Mary LawsonDirector of EducationWhat is meant by“CanMEDS”?“CanMEDS” is a curriculum frameworkdeveloped for use in medical education. Itsname is derived from “Canadian MedicalEducation Directives for Specialists”.The framework sets the standard for alldomains of professional practice includingthe knowledge, skills and behavioursexpected of specialists in Canada(and those countries that adopt it).CanMEDS was an initiative by theRoyal College of Physicians and Surgeonsof Canada in the 1990s. At that time, theCollege recognised that the healthcareenvironment was undergoing rapidchanges such as patient consumerism,an increasingly regulatory environment,budgetary constraints, access to medicalinformation freely via the internet,higher rates of litigation, new drugs andtechnologies and the explosion of medicalknowledge. These forces were changing thehealthcare delivery environment, and it wasfelt that the roles and abilities of physicians(doctors) urgently needed to adapt tothese changes.After many years of extensiveconsultative process involving doctorsfrom many fields and educators and otherstakeholders such as patient groups, seven“essential physician roles” were defined. 1The CanMEDS Roles: Medical Expert,Communicator, Collaborator, Manager,Health Advocate, Scholar, ProfessionalIt was decided that training in theseroles would provide the basis for medicaleducation to prepare specialist doctors forpractice that could meet patients’ needsin the modern healthcare environment.Universities and specialist training programsin Canada adopted the principles intotheir curricula, and it was not long beforemany other countries followed suit atdifferent levels across the spectrumof medical education.Remembering the North Americanorigins of the CanMEDS, “physician”would in our context equate to “medicalspecialist” and “medical expert” toexpertise in the medical aspects of one’sspecialty rather than specifically tospecialist medicine (what we wouldcall physician specialist practice).56The ANZCA Bulletin June 2009

The CanMEDS Roles are typicallyrepresented by the diagram 2 , the CanMEDS“daisy”. It shows the centrality of the roleof “Medical Expert” with all the otherroles interconnected. Each CanMEDSrole also has a list of “Elements”, whichexplain the role more clearly. The “daisy”is a simplistic representation of thiscomplex framework.©2001-2006 The Royal College of Physicians and Surgeons of Canadawww.rcpsc.medical.orgThe CanMEDS CompetenciesIn 1995, the CanMEDS framework wasrevised 3 to be more than just a descriptionof essential physician roles, and wenton to describe essential competencies.(Competencies are important knowledge,skills and attitudes that can be taught,observed and assessed).Competencies have now been organisedaround the physician roles. In the CanMEDSframework each of the seven Roles has “KeyCompetencies”, and each key competencyhas been further outlined into multiple“Enabling Competencies”. The enablingcompetencies specify the behaviours, skillsand attitudes that must be displayed by thepostgraduate learner.As an example, here is the descriptionof the key competencies for theCommunicator Role:“As Communicators, physicianseffectively facilitate the doctor-patientrelationship and the dynamic exchangesthat occur before, during, and after themedical encounter.” 3Key Competencies forthe Communicator Role1. Develop rapport, trust and ethicaltherapeutic relationships with patientsand families2. Accurately elicit and synthesizerelevant information and perspectivesof patients and families, colleaguesand other professionals3. Accurately convey relevant informationand explanations to patients andfamilies, colleagues and otherprofessionals4. Develop a common understandingon issues, problems and plans withpatients and families, colleaguesand other professionals to developa shared plan of care5. Convey effective oral and writteninformation about a medical encounterEach of the five key competencies listedabove has enabling competencies whichexpand on exactly what is required(17 in total). For example, the enablingcompetencies for point 4 taken from theCommunicator Role are listed below:4. Develop a common understandingon issues, problems and planswith patients, families, and otherprofessionals to develop a sharedplan of care4.1 Effectively identify and exploreproblems to be addressed from apatient encounter, including thepatient’s context, responses,concerns, and preferences4.2 Respect diversity and difference,including but not limited to theimpact of gender, religion andcultural beliefs on decision-making4.3 Encourage discussion, questions,and interaction in the encounter4.4 Engage patients, families, andrelevant health professionalsin shared decision-making todevelop a plan of care4.5 Effectively address challengingcommunication issues such asobtaining informed consent,delivering bad news, andaddressing anger, confusionand misunderstandingMany of the specialist medical collegesof Australia (including ANZCA) haveincorporated the CanMEDS framework intotheir curricula, with some adaptations.The FANZCA program is undergoingan extensive review, and the revisedprogram will more explicitly incorporatethe framework, with Key and Enablingcompetencies as described above, pertinentto Australasian anaesthesia, included inthe curriculum.Trainees and IMGS undertaking theFANZCA Final Examination would benefitfrom reading the CanMEDS frameworkand ANZCA Code of Professional Conduct 4for a clear idea of the standard and rangeof abilities that are expected to have beenachieved by the end of training to deliverquality care as a specialist.A full description of the CanMEDSframework can be found at:http://rcpsc.medical.org/canmeds/Dr Genevieve GouldingANZCA CouncillorChair IMGS CommitteeDeputy Chair Education & TrainingCommitteeReferences:1. The Royal College of Physicians and Surgeonsof Canada, RCPSC: The CanMEDS ProjectOverview (2005). http://rcpsc.medical.org/canmeds/CanMeds-summary_e.pdf2. The Royal College of Physicians and Surgeonsof Canada, RCPSC: Website. http://rcpsc.medical.org/canmeds/3. Frank, JR. (Ed). 2005. The CanMEDS 2005physician competency framework. Betterstandards. Better physicians. Better care.Ottawa: The Royal College of Physicians andSurgeons of Canada.4. The ANZCA Code of Professional Conduct2007. http://www.anzca.edu.au/resourcesguidelines/Code-of-Conduct.pdfThe ANZCA Bulletin June 2009 57

Victorian Regional CommitteeCall for AbstractsAnnual Victorian Registrars’Scientific Meeting9.30am Friday, September 25, 2009ANZCA House, Ground FloorThe Auditorium, 630 St Kilda Road,Melbourne Victoria 3004Registrars are strongly encouraged to participate in this Meeting.Please submit an abstract (250 word limit) via email tovic@anzca.edu.au by Friday, August 14, 2009 accompaniedby the Declaration Form duly completed.If you wish your presentation to be considered as your FormalProject, a written submission consisting of 1500 words must besent to the Formal Project Officer after the Meeting.All presenters are required to register for the Meeting. The registrationform can be found at our website: www.vic.anzca.edu.au/eventsRegistration Fees:Fellows $55Trainees $44Retirees $30(Includes Day Meeting and Booklet of Abstracts)For further information visit our website:www.vic.anzca.edu.au/eventsOr contact:Daphne ErlerVictorian Regional Co-ordinatorAustralian & New Zealand College of Anaesthetists630 St Kilda RoadMelbourne VIC 3004Phone: (03) 9510 6299 or (03) 8517 5313Fax: (03) 9510 6786Victorian Regional Committee30th Annual ANZCA/ASACombined CME Meeting“Anaesthesia Right Now!”A Clinical UpdatePresentations will target anaesthesia inextreme circumstances, diabetes, obesityand a number of important guideline updates.8am Saturday, July 25, 2009Sofitel Hotel, 25 Collins Street, Melbourne 3000Registration – inclusive of GSTFellows $297Trainees $217Retirees $66Dinner $120For information visit our website:www.vic.anzca.edu.au/eventsOr contact:Daphne ErlerVictorian Regional Co-ordinatorAustralian & New Zealand College of AnaesthetistsVictorian Regional Committee630 St Kilda RoadMelbourne VIC 3004Email: vic@anzca.edu.auPhone: (03) 9510 6299 or (03)8517 5313Fax: (03) 9510 6786 or (03) 8517 536058The ANZCA Bulletin June 2009

fellowship affairsContinuing ProfessionalDevelopment: Planningfor your futureContinuing Professional Development(CPD) concerns us all. As a profession, weare committed to providing the highestquality of safe and effective patient care.With the rate of change of knowledge in ourdiscipline it is essential that we continueto learn, refine and develop our skillsthroughout our professional life.The College, recognising the importanceof CPD, mandated the new ANZCA CPDprogram in January, 2009. There aresome inevitable problems associated withmandating an activity across a profession.Importantly, it has to be recognised thatthere are two roles of a CPD program andthey may not sit entirely comfortablytogether but clearly the net position is apositive one for both the individualand the profession.In designing the ANZCA CPD program,there have been two major considerations:• How do we design a program that willsupport all specialist anaesthetists tomaintain the highest possible standardsof patient care over a lifetime ofprofessional practice?• How can we ensure that this programis both flexible in meeting the needsof a diverse workforce and rigorous inensuring that standards are maintained?Professor Phillips summarised that “thenew CPD program caters for non-clinicians,including people in administration, research,teaching, overseas aid as well as clinicians.It can also be used by Fellows who are justplain retired”. He found the completionof the program requirements to berelatively straightforward.CPD is not (and should not) be limitedto learning a relatively narrow range ofskills and knowledge for your clinicalpractice. This is important but it fails toacknowledge the broad framework in whichwe practice our professional trade. TheANZCA curriculum framework adopts theCanMEDS framework and this may be auseful way to conceptualise the areas wherewe could focus for CPD. For example, itmay include any activity that develops yourskills to undertake the entire scope of yourwork commitments, for example:• Knowledge (specific areas to update ornew information to learn)• Procedural skills (specific skills to updateor new skills to learn)• Developing your teaching andeducational skills (this could includeeducation research or leadership as wellas more traditional delivery of teaching)• Clinical problem solving• Responding to clinical emergencies• Communicating effectively with patientsand colleagues• Handling conflict in the workplace• Management of work and time• Organisation and teamwork skills• Change management• Engaging effectively in clinical qualityassurance activities and auditThere has been growing support for theparticipation in a CPD program and this canbe seen in the latest communiqué from theAustralian Health Workforce MinisterialCouncil on May 8 (see www.nhwt.gov.au).The new ANZCA CPD program is theway of the future. It is seen as one of themost intuitive and structurally soundprograms, and 68% of the Fellowship havecommenced their program and found itto be flexible to their needs and easy toachieve the required credits. As highlightedby one of the participating Fellows: “It looksgood in that it is personalised learning withobjectives and getting the individual toreflect on what has been done. The toolkitsare crucial. We will now have to get out ofour comfort zone and adjust to thenew program.”Participation in the ANZCA CPD programinvolves the following components:• CPD is a three-year program based oncalendar years;• Participation is via the online portfolio oroffline portfolio;• In the first year of the triennium you needto develop a CPD plan;• Over the three years you need to obtain:- 30 credits in Category 1, GroupLearning Activities;- 30 credits in Category 2,Self Learning Activities;- 30 credits in Category 3,Practice Assessment Activities;- An additional 30 credits from any of theabove three Categories or Category 4,Educational Development Activities;• In the last year of the triennium youneed to evaluate your activities about thelearning objectives you set out in yourCPD plan.There are a number of benefits toparticipants of the revised program.These include:• You will be able to print out a Statementof Participation whenever you requireone;• Activities can be targeted to meet yourspecific learning needs;• With the introduction of a three-yearprogram, credits can be carried overbetween the years within the triennium,• A broad range of activities can beincluded in the program.ANZCA staff can provide assistance andanswer any questions. This includes helpin navigating the online program. They cantalk you through what you need to recordand how to record it. They can also assistwith determining where the activities youundertake fit within the program. Pleasedo not hesitate to contact the CPD Unit on+61 3 9510 6299 or by emailingcpd@anzca.edu.au.Dr Michelle MulliganChair, Fellowship Affairs CommitteeThe ANZCA Bulletin June 2009 59

2009 Combined Medical Education, Simulation,Welfare and Management SIG Meeting‘Essential Skills for the Future’The Byron at Byron, Byron Bay, Northern NSW9–11 October 2009Call for Abstracts: A number of free paper sessions on the areas ofAnaesthesia Education, Simulation and Skills Training, Managementand Welfare issues will be included in the meeting. Delegates areinvited to submit an abstract of 300 words for these sessions by9 August 2009. Please forward your abstract to the conferenceorganiser Ms Gay Hopgood. ghopgood@anzca.edu.auTo view the program visit:www.anzca.edu.au/fellows/sig/medical-education-sigFor further information please contact:Gay HopgoodFellowship Affairs CoordinatorANZCA Continuing Professional DevelopmentTel: +61 3 9510 6299Email: ghopgood@anzca.edu.auNew South Wales Regional CommitteeAustralian and New Zealand College of AnaesthetistsPrimary Refresher Coursein AnaesthesiaThe Course is a full-time revision course, run on a lecture/tutorialbasis and is suitable for candidates presenting for their PrimaryExamination in the first part of 2010. The first week will cover mainlyPhysiology topics and the second week Pharmacology topics.DateMonday 12 October – Friday 16 October, 2009 (Physiology)Monday 19 October – Friday 23 October, 2009 (Pharmacology)VenueLarge Conference Room, Kerry Packer Education CentreRoyal Prince Alfred Hospital, Missenden Road,Camperdown, NSW 2050FeeA$880.00 (incl gst) (2 weeks)A$440.00 (incl gst) (1 week)In addition, a comprehensive set of supplementary notes, lecturesnotes and CD will be given to each participant at the commencementof the Course.Applications CloseFriday 25 September, 2009 (if not filled prior)The number of participants for the Course will be limitedFor information contact: Mia BratsalisANZCA New South Wales Regional Committee117 Alexander Street, Crows Nest NSW 2065Email: nswcourses@anzca.edu.auPhone: (02) 9966 9085Fax: (02) 9966 908760The ANZCA Bulletin June 2009

Australian and New Zealand College of AnaesthetistsAustralian Society of AnaesthetistsNew Zealand Society of AnaesthetistsCardiothoracic, Vascular and Perfusionspecial interest group conferenceSheraton Noosa 4-7 October 2009The CVP SIG Executive takes great pleasure in inviting you to its 10th Biennial ContinuingEducation Meeting to be held at the Sheraton Noosa Resort and Spa from the 4th-6th October2009 . The goal of this meeting is to present material in a number of key areas and allow forbroad discussion and exchange of ideas amongst delegates.We will be covering a broad range of topics and audience participation will be encouraged. Onesession will be devoted to interactive case presentations to take advantage of the great expertiseand clinical experience within the Special Interest Group membership. An Echoworkshop will beheld on the 7th October from 0900-1230 as a satellite to the meeting.The key invited speaker will be Dr David Reich. Dr Reich is a professor of anesthesiology at theMount Sinai School of Medicine in Manhattan NYC. He is also the vice chairman for academicaffairs in the department of anesthesiology and a director of the division of cardiothoracicanesthesia at the Mount Sinai Medical Center, also in Manhattan.For further details please contact the conference coordinator:Kate Briggs T: +61 3 9510 6299 E: kbriggs@anzca.edu.auwww.anzca.edu.au/fellows/sig/cvp-sig/2009-cvp-sig-conferenceCardiothoracic, Vascular and PerfusionSpecial Interest Group Conference4-7 October 2009Sheraton NoosaCall for AbstractsThe Organising Committee invites you to submit abstracts on cardiothoracic, vascular,perfusion and echocardiography for a poster presentation at the 2009 CVP SIGconference. All accepted abstracts will be published in the meeting Abstract Book.A prize and certificate will be awarded for the best poster at the conference dinner.The closing date for submissions is the 4 th September 2009. All abstracts (max 300words) must be submitted in MS word format via email to Kate Briggs,kbriggs@anzca.edu.auThe ANZCA Bulletin June 2009 61

Library updateECRI Institute noticesThe ANZCA Library subscribes to ECRIpublications on operating room riskmanagement and health device alerts andinformation. Check this space regularly forupdates on the latest information producedby ECRI.Recent notices include:• Anesthesia Department Self-AssessmentQuestionnaire• Anesthesia kit alerts• Intensive Care Ventilators Evaluation– an evaluation of 7 models• Overview of Anesthesia Safety• Clinical Alarms• High-Risk Health Technology Hazards• Sharps Injury Prevention TrainingProgram• Hand Hygiene in the Healthcare SettingHealth Devices, Vol. 38, No. 4, April 2009– Hazard Report – A lifesaving reminder:improper use of ventilator alarms placespatients at risk.Contact the ANZCA Library forfurther information.New resourcesHistoria Medica – a collection ofpapers and lectures relating principallyto the history of anaesthesia(mainly in New Zealand).Donated by the author, Dr Basil RHutchinson, 2009.Australian and New Zealand HealthPolicy has recently been added to theANZCA Library online journal list.The journal is freely available at:http://www.anzhealthpolicy.com/homeAustralian Resuscitation CouncilRevised Guidelines:Guideline 8.4 ShockGuideline 8.8 Hypothermia: First AidManagementGuideline 8.23 Anaphylaxis: First AidManagementAvailable in hardcopy fromthe ANZCA Library or online at:http://www.resus.org.auDonationsMany thanks to Dr Nick Jansen fordonating recent issues of the NewEngland Journal of Medicine and the MedicalJournal of Australia.Thank you to Professor W J Russell forconverting a variety of audiovisual materialto DVD and supplying them to the library.New research resourcesHaving trouble understanding medicalliterature or submitting a report?The journal, Chest, provides monthlymedical writing tips such as:• Abstracts for Professional Meetings: SmallBut Mighty• Keep Attendees Awake: Writing EffectivePresentations for International Conferences• Development of International Standardsfor Medical Communications in Englishhttp://www.chestjournal.org/cgi/collection/mwtBecker Medical Library Model forAssessment of Research ImpactThe Becker Medical Library Model forAssessment of Research Impact representsa practical, do-it-yourself tool for trackingthe impact of biomedical research. Themodel includes guidance for quantifyingand documenting research impact as wellas resources for locating evidence ofresearch impact.http://becker.wustl.edu/impact/assessment/index.htmlDatabaseimprovementsTwo major medical databases OvidSPMedline and OvidSP Embase have recentlyundergone a number of enhancements.Improvements include:• enhanced limit to publication year• links to fulltext PDFs in the citationwhen available• links to fulltext when exportingto a reference manager or emailingto a colleague.The ANZCA Library subscribes to both thesedatabases and tutorials have been added tothe Database section of the Library website.While these are generic tutorials on usingthe database, the ANZCA Library staffare always available to assist with anyfurther queries.New titlesAnesthesiologist’s manual of surgicalprocedures / Jaffe, Richard A [ed.];Samuels, Stanley I [ed.]. -- 4th ed --Philadelphia, PA: Wolters Kluwer/LippincottWilliams and Wilkins, 2009.Clinical anesthesia / Barash, Paul G [ed];Cullen, Bruce F [ed]; Stoelting, Robert K[ed]; Cahalan, Michael K [ed]; Stock, MChristine [ed]. -- 6th ed -- Philadelphia, PA:Lippincott Williams and Wilkins, 2009Crisis management in acute caresettings: Human factors and teampsychology in a high stakes environment/ St Pierre, Michael; Hofinger, Gesine;Buerschaper, Cornelius. -- Berlin:Springer, 2008.62The ANZCA Bulletin June 2009

Essential guide to generic skills /Cooper, Nicola; Forrest, Kirsty; Cramp,Paul. -- Malden, Mass.: BMJ Books, 2006.Evidence-based practice ofanesthesiology / Fleisher, Lee A [ed].-- 2nd ed -- Philadelphia, PA: SaundersElsevier, 2009.Handbook for Stoelting’s anesthesia andco-existing disease / Hines, Roberta L[ed]; Marschall, Katherine E [ed]. -- 3rd ed --Philadelphia, PA: Saunders Elsevier, 2009.Multiple choice questions in intensivecare medicine / Benington, Steve;Nightingale, Peter; Shelly, Maire. --Shrewsbury, UK: tfm Publishing, 2009.The pocket guide to teaching for medicalinstructors / Bullock, Ian [ed]; Davis, Mike[ed]; Lockey, Andrew [ed]; Mackway-Jones,Kevin [ed]. / Advanced Life Support Group;Resuscitation Council (UK). -- 2nd ed --Malden, MA: Blackwell Publishing, 2008.Review of clinical anesthesia / Connelly,Neil R [ed]; Silverman, David G [ed]. -- 5thed -- Philadelphia, PA: Lippincott Williamsand Wilkins, 2009.The structured oral examination inclinical anaesthesia: Practice examinationpapers / Mendonca, Cyprian; Hillermann,Carl; James, Josephine; Kumar, G S Anil.-- Shrewsbury, UK: tfm PublishingLimited, 2009.Vander’s renal physiology / Eaton,Douglas C; Pooler, John P. -- 7th ed-- New York: McGraw-Hill, 2009.Most popular books1. Anaesthetic equipment / Rosewarne F.-- Melbourne: F. Rosewarne2. Anatomy for anaesthetists / Ellis,Harold; Feldman, Stanley. -- 8th ed --Carlton, Vic.: Blackwell Publishing, 2004.3. Yao and Artusio’s anesthesiology :problem-oriented patient management/ Yao, Fun-Sun F [ed]; Malhotra, Vinod[ed]; Fontes, Manuel L [ed]. -- 6th ed --Philadelphia: Lippincott Williamsand Wilkins, 2008.4. Anesthesia and co-existing disease /Stoelting, Robert K; Dierdorf, Stephen F.-- 4th ed -- New York: ChurchillLivingstone, 2002.5. Cardiovascular physiology / Levy,Matthew N; Pappano, Achilles J. -- 9th ed-- Philadelphia: Mosby Elsevier, 2007.6. Management of the difficult and failedairway / Hung, Orlando R [ed]; Murphy,Michael F [ed]. -- New York: McGraw-HillMedical, 2008.7. Board stiff three: Preparing for theanesthesia orals / Gallagher, ChristopherJ. -- 3rd ed -- Philadelphia, PA:Butterworth Heinemann Elsevier, 2009.8. Obstetric anaesthesia / Clyburn, Paul[ed]; Collis, Rachel [ed]; Harries, Sarah[ed]; Davies, Stuart [ed]. -- New York:Oxford University Press, 2008.9. Crisis management in anesthesiology/ Gaba, David M; Fish, Kevin J; Howard,Steven K. -- New York ; Melbourne:Churchill Livingstone, 1994.10. Evidence-based anaesthesia andintensive care / Moller, Ann [ed];Pedersen, Tom [ed]. -- Cambridge:Cambridge University Press, 2006.News ItemsIntravenous or intramuscular parecoxibfor acute postoperative pain in adults /Cochrane Database Syst Rev. 2009 Apr 15;(2)http://www.cochrane.org/reviews/en/ab004771.htmlSystematic review of the clinical effectivenessand cost-effectiveness of oesophagealDoppler monitoring in critically ill andhigh-risk surgical patients / HealthTechnology Assessment 2009;13(7):1–118.The study found that, although oesophagealDoppler monitoring is likely to be of bothclinical and economic benefit in high-risksurgical patients, insufficient evidence isavailable to recommend its widespreaduse in critically ill patients.http://www.hta.ac.uk/project/1633.aspGuideline for the management ofpostoperative nausea and vomiting / Societyof Obstetricians and Gynaecologists of CanadaThe aim of these guidelines is to providerecommendations for the management ofPONV in gynaecological patients.http://www.sogc.org/guidelines/documents/gui209CPG0807.pdfConversion of epidural labour analgesiato anaesthesia for Caesarean section: aprospective study of the incidence anddeterminants of failure / Br J Anaesth 2009;102(2): 240-3Intraoperative conversion to GA mayincrease both maternal and foetal risks.Available online via the ANZCA JournalList: http://www.anzca.edu.au/resources/library/online-journals.htmlOpen vs specific questioning duringanaesthetic follow-up after Caesareansection / Anaesthesia 2009; 64(2): 156-60Available online via the ANZCA JournalList: http://www.anzca.edu.au/resources/library/online-journals.htmlThe ANZCA Bulletin June 2009 63

Library updateContinuedPrediction and outcomes of impossible maskventilation: a review of 50,000 anesthetics /Anesthesiology 2009; 110: 891-7Impossible mask ventilation is aninfrequent airway event that is associatedwith difficult intubation. Neck radiationchanges represent the most significantclinical predictor of impossible maskventilation in the patient dataset.Available online via the ANZCA JournalList: http://www.anzca.edu.au/resources/library/online-journals.htmlHaptic simulator for epiduralsResearchers at the University of Limerick inIreland have created a spinal anaestheticsimulation program as a training tool.“The ‘haptic simulator’ recreates the skintension felt by the practitioner at the pointthe needle is inserted.If the injection is not carried out correctly,the trainee receives immediate audio andvisual feedback.”BBC report: http://news.bbc.co.uk/2/hi/science/nature/7948300.stmProject website: http://www.idc.ul.ie/dbmt/technology.htmlAAGBI safety guideline: pre-hospitalanaesthesiaPre-hospital anaesthesia is carried outregularly only by a small number of doctorsin the UK. Although mostly predictable, prehospitalconditions can be more difficultthan those in hospital and, in addition,trained assistance and peer support is notusually available. It is therefore importantthat patient safety is paramount andsystems are in place to ensure that thehighest standards are achieved.http://www.aagbi.org/publications/guidelines/docs/prehospital_glossy09.pdfLong-term consequences of postoperativecognitive dysfunction / Anesthesiology. 2009Mar;110(3):548-55.Available online via the ANZCA JournalList: http://www.anzca.edu.au/resources/library/online-journals.htmlA Healthier Future for All Australians /National Health and Hospitals ReformCommission1. Taking Responsibility2. Connecting Care3. Facing Inequities4. Driving Quality Performancehttp://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/interim-reportdecember-2008Music during caesarean section underregional anaesthesia for improving maternaland infant outcomes / Cochrane DatabaseSyst Rev. 2009 Apr 15;(2)http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006914/frame.htmlWHO guidelines on hand hygiene inhealth careThese guidelines review the scientificdata, state consensus recommendationsand provide information on process andoutcome measurement.http://whqlibdoc.who.int publications/2009/9789241597906_eng.pdfNew 7th edition of Miller’sAnaesthesia – special offer toANZCA membersThe ANZCA Library has arranged aspecial offer on the new edition ofMiller’s Anaesthesia, 7th edition2009 in conjunction with SPP Books.The premium version of Miller’sAnaesthesia, normally priced at$730, is on an introductory offer of$599 net and free delivery withinAustralia.The expert consult version of Miller’sAnaesthesia, normally priced at$550.00, is on an introductory offerof $449.00 net and free deliverywithin Australia.In addition to these savings,announce yourself to SPP Books asa ANZCA member and receive withyour purchase of Miller’s Anaesthesiaa gift voucher to the value of $20 tobe used against any purchase at SPPBooks in the next 12 months.This offer is valid until July 31, 2009.Contact the Library OR SPP directly:SPP Books, 688 Elizabeth Street,Melbourne, VIC 3000Phone: +61 3 9341 7000Fax: +61 3 9341 7097Freecall: 1800 333 672www.sppbooks.com.auEmail: info@sppbooks.com.auContact the Librarywww.anzca.edu.au/resources/libraryPhone: +61 3 8517 5305Fax: +61 3 8517 5381Email: library@anzca.edu.au64The ANZCA Bulletin June 2009

RegionsAustralian CapitalTerritoryThe new Australian Capital Territory(ACT) office proved a suitable venue fora productive Continuing ProfessionalDevelopment (CPD) workshop on Saturday,May 23. Under the guidance of VidaViliunas, Fellows were able to log onto the ANZCA website, set up and updatetheir CPD portfolio.On July 18, a Clinical Teaching Course(CTC) workshop will also be held. Thiswill provide an opportunity for Fellowsinvolved in supervision to structure theirapproach to teaching and learning in aclinical environment.Planning continues for the popularFloriade Meeting to be held from September19-20, with the theme “Anaesthesia forRenal and Vascular Surgery”. A new venueis being planned and further details will beadvertised on the ANZCA website shortly.The Society for Paediatric Anaesthesiain New Zealand and Australia (SPANZA)Annual Scientific Meeting will be held atthe Hyatt Hotel between October 29 andNovember 1. Professor Stephen Stayeris the international guest and the themeof the meeting is “New Frontiers inPaediatric Anaesthesia”.ACT Fellows are also looking forwardto welcoming local and interstate gueststo the official opening of the new officeson June 23, 2009.New South WalesContinuing Medical Education MeetingDate: Saturday and Sunday,November 14-15, 2009Where: Novotel Wollongong Hotel,Northbeach, WollongongTitle: “Risky Business: The Art and Scienceof Preoperative Assessment”This meeting will focus on a rangeof issues surrounding preoperative care.What are the risks for patients, how welldo we assess this risk, what does testingtell us, how does it improve patients andis preoperative testing even necessary?There will be numerous speakers fromdifferent specialties who will talk aboutcurrent best practice and evidencebasedtesting.The meeting will also incorporateworkshops, small group discussions andlectures, designed to stimulate thinkingabout what is best for patients.This meeting is suitable for practicinganaesthetists and also has relevanceto trainees preparing for their finalexaminations.Primary Refresher Course in AnaesthesiaThe Primary Refresher Course inAnaesthesia was held at the Royal PrinceAlfred Hospital during May and was wellattended. The NSW Regional Committeethanks the lecturers who put in a hugeamount of time and effort in helpingtrainees prepare for their forthcomingexaminations. Special thanks also goesto the convenor of the course, ProfessorPeter Kam. Professor Kam has overseen thiscourse for more than two decades. The nextPrimary Refresher Course in Anaesthesiawill be held at the Royal Prince AlfredHospital from October 12 – 23, 2009.Trial VivasTo assist candidates presenting for theirFinal Anaesthetic Vivas in Melbourneon May 29-30, trial vivas were conductedat Liverpool, Westmead, Royal PrinceAlfred and St George Hospitals. Onceagain, Fellows and trainees at each of theanaesthetic departments volunteered theirtime to assist in organising these successfultrial viva evenings and we thank everyoneinvolved. The next trial viva evenings willbe held in September and October 2009.Please also note that the Part Zero“Introduction to Anaesthesia” coursescheduled for later in the year has beenpostponed until February 2010.Clinical Teaching Course workshopA Clinical Teaching Course (CTC) workshopwas held at the Sydney ANZCA office onMarch 27. Conducted by Felicity Hutton(Education, Training and Developmentmanager at ANZCA), the day workshopfocused on “Teaching in Small Groups”.Participants were encouraged to exploreways they could use small groups as amethod of teaching anaesthesia. Theactivities and discussions were focusedon developing understanding of smallgroup dynamics and strategies to promotemaximum participation of all groupmembers. The workshop also provideda good opportunity for participants toplan, conduct and evaluate a small groupteaching activity.For updates and future meetingsplease visit the NSW regional website:www.nsw.anzca.edu.auTop: Novotel Wollongong at Northbeachin New South Wales;Above from left, back row: D. Wolfers,J.Poulos, A. Singh, H. Abouelnasr,J.Killen, S.Wharton, J.Prowse,T.Selak;front row: A.Playoust, N.Smith, T.Tay,F.Hutton, Y-L.Wan.The ANZCA Bulletin June 2009 65

New South Wales Regional CommitteeAustralian and New Zealand College of AnaesthetistsPrimary Refresher Coursein AnaesthesiaThe course is a full-time revision course, run on a lecture/tutorialbasis and is suitable for candidates presenting for their primaryexamination in the first part of 2010. The first week will cover mainlyphysiology topics and the second week pharmacology topics.DateMonday, October 12 – Friday, October 16, 2009 (Physiology)Monday, October 19 – Friday, October 23, 2009 (Pharmacology)VenueLarge Conference Room, Kerry Packer Education CentreRoyal Prince Alfred Hospital, Missenden Road,Camperdown, NSW 2050FeeA$880 (incl gst) (2 weeks)A$440 (incl gst) (1 week)In addition, a comprehensive set of supplementary notes, lecturesnotes and CD will be given to each participant at the commencementof the course.Applications closeFriday, September 25, 2009 (if not filled prior)The number of participants for the Course will be limitedFor information contact: Mia BratsalisANZCA New South Wales Regional Committee117 Alexander Street, Crows Nest NSW 2065Email: nswcourses@anzca.edu.auPhone: (02) 9966 9085Fax: (02) 9966 9087Oxygen and the AnaesthetistLet’s get to grips with this most basicof human requirements. Oxygen is integralto our daily activity in anaesthesia, buthow much do we really know about it?Saturday, August 8, 2009Hilton Sydney Hotel, 488 George Street, SydneyBrochure, registration and workshop papers are also availableon the NSW ANZCA website: www.nsw.anzca.edu.au/events66The ANZCA Bulletin June 2009

RegionsContinuedQueenslandThe Faculty of Pain Medicine (FPM)Queensland Regional Committee (QRC)was fortunate to have Professor AndrewRice from the United Kingdom speak atits recent Continuing Medical Education(CME) Dinner Meeting. The convenor wasDr Wilbur Chan and the meeting was heldon Tuesday, May 5 in Brisbane at the ANZCAQueensland office.Andrew Rice is Professor of PainResearch at the Imperial College London,where he is active in both laboratoryresearch and clinical medicine.Prof Rice is author of more than 75scientific publications and sits on theeditorial boards of Pain and Public Libraryof Science–Medicine. He conceived and islead editor for the Textbook of Clinical PainManagement, now in its second edition.He was the Covino Lecturer at HarvardUniversity in 2008, a plenary lecturer atthe 10th World Congress of Pain in 2002and was the Patrick D. Wall Professor atthe Royal College of Anaesthetists in 1998.Prof Rice is an honorary consultantin Pain Medicine at the Chelsea andWestminster Hospital, London, where heprovides a clinical service for patientssuffering from neuropathic pain, inparticular post herpetic neuralgia andHIV neuropathy.He spoke on pain and patients with HIVat the Queensland Dinner Meeting.South Australia /Northern TerritoryAccreditation Training workshopThirteen participants from around Australiaand New Zealand attended an accreditationtraining workshop held at the Adelaideoffice on May 16.Associate Professor Kate Leslie, Chair ofthe Training Accreditation Committee (TAC),and Dr Bronwyn Hartwig from the CognitiveInstitute, facilitated the workshop.A/Prof Leslie demonstrated the use ofthe TAC’s new web-based hospital datasheet and accreditation report and guidedparticipants through the accreditationhandbook and the guidelines for writingrecommendations, using examples froma de-identified hospital.Dr Hartwig discussed the challengesand concerns that might be faced by bothinterviewer and interviewee. She alsoprovided strategies for addressing theseand how to maximise the benefit of theinspection process for both the Collegeand the hospitals.Participants used role-play topractice the tactics they learned duringthe workshop and are now eligible toparticipate in hospital inspections outsidetheir own region.South Australia Medical Careers ExpoThe South Australia Medical Careers Expowas held on Sunday, May 24 at the RidleyPavilion in the Adelaide Event &Exhibition Centre.The expo was open to final-year studentsand early graduate trainees. Dr RichardWillis and Dr Thien Le Cong attended andprovided information on anaesthesia asa career and ANZCA’s training program.The event was also supported by Dr SuzySzekely and Dr Neil Maycock.Clockwise from above left: Prof Andrew Rice;Dr Bronwyn Hartwig (presenter), A/ProfSandy Garden, Dr Lynne Rainey, Dr CharlieClegg, Dr Jodi Graham; Dr Richard Willisand Dr Thien Le Cong at the MedicalCareers Expo.The ANZCA Bulletin June 2009 67

RegionsContinuedVictoriaClockwise from top Left: Small groupscenarios; Raje Rajasekaram, DrKushlani Stevenson, Dr Richard Horton(Victorian Regional Education Officer),Dr Adrian Grigo; Fibre-optic workshop.TasmaniaA Clinical Teaching Workshop entitled“Teaching in the Operating Theatre” forconsultants will be held at the LauncestonGeneral Hospital on Friday, June 26.Another workshop entitled “Introductionto Ultrasound in Anaesthesia” will also beheld in Launceston on July 11.Dr Peter Hebbard will facilitate thishands-on workshop which will cover:- Ultrasound physics and knobology,- Nerve blocks and vascular accessupper body- Nerve blocks and vascular accesslower body- TAP (Transversus Abdominis Plane) blockThis workshop is being sponsoredby AstraZeneca and Sonosite.Airway Refresher WorkshopA successful Airway Refresher Workshopwas held on Saturday, May 16 at the Collegeattended by 152 Victorian Fellowsand trainees.The program included presentations,small group discussions and a rangeof practical skills stations including:fibre-optic, video laryngoscopic andcricothyroid approaches to the airway.Thank you to the convenor,Dr Rod Tayler, and all the presentersand participants.Dr Rowan ThomasChair, Victorian Regional Committee2009 Rural Careers WeekendOn behalf of the College, Dr AndrewHaughton attended the 2009 Rural CareersWeekend at Wangaratta on Saturday,March 28, 2009.This was an ideal forum to highlight theCollege training programs in a rural context.Approximately 60 delegates attended fromrural and metropolitan clinical schools andthere was a lot of interest in rural trainingopportunities in becoming a Fellowof ANZCA.One interesting observation Dr Haughtonmade from attending this event was thatnumerous medical students were alreadybeginning to formulate career plans, butfew had approached anaesthetists forthis purpose.68The ANZCA Bulletin June 2009

Western AustraliaThe WA 2009 Autumn Scientific MeetingThe Annual Autumn Scientific Meeting washeld on Saturday, March 21, 2009 at theUniversity Club of Western Australia.The theme of the meeting was “Updatesin Acute Pain”. The meeting was againcombined with the annual conferenceof the Western Australian Society ofAnaesthesia Technicians (WASAT) andwas well supported with more than130 anaesthetists and 40 techniciansin attendance.Associate Professor David Scott was theAustralian Society of Anaesthetists (ASA)75th Anniversary Invited Speaker and hedelivered a lecture on “The Progressionof Acute to Chronic Pain”. He also rana problem-based learning discussion(PBLD) and registrars session. Dr Scott’scontribution was greatly appreciatedand made for an enjoyable andinformative meeting.Continuing with the theme of acutepain, Dr Priya Thalayasingam delivered apresentation on “Acute Pain Managementin Children”, A/Prof Scott ran a PBLD on“Polypharmacy in Acute Pain” and DrSai Fong ran a discussion session on theperioperative management of acute painin complex patients and a PBLD on “APractical Approach to CPD”. Ms PamelaMalcolm from the Western AustraliaMedical Board also gave an update on theMedical Act.The 2009 Nerida Dilworth Prize, awardedto an anaesthetic registrar in WesternAustralia who contributes significantly tothe ASA and/or ANZCA, was awarded toDr Angela Palumbo.The 2008 D.R.C. Wilson Memorial Lecture“Standards, Status, Stress and Senescence”was delivered by Dr Geoff Mullins.IMGS & WBA workshopProfessor Garry Phillips and Dr MichelleJoseph visited the Western Australia officeon April 23 to conduct a Workplace BasedAssessment (WBA) workshop. Duringthe morning session, Professor Phillipsexplained the International MedicalGraduate Specialist (IMGS) process thatcommenced on January 1, 2009 and thenDr Joseph explained the WBA process. Thefollowing Fellows were nominated by theWestern Australia Regional Committee(WARC) to attend the workshop: Drs JohnAnderson, Jenny Stedmon, Peter Platt,Richard Riley, Alison Corbett, AileenDonaghy, Simon Maclaurin, Mark Williams,Lars Wang and Jay Bruce.CPD presentationProfessor Garry Phillips also delivered aContinuing Professional Development (CPD)presentation during his visit to Perth onApril 23. The session was held at the St Johnof God Hospital, Subiaco Conference Centreand 25 Fellows attended.Upcoming WA CME events for 2009The Winter Scientific Meeting was held onJune 13, 2009 at the Perth Convention andExhibition Centre. The meeting was entitled“The Heart of the Matter”. Topics includeda paediatric refresher session (includingcongenital cardiac disease and off licenceuse of drugs) and an adult cardiovascularsession including pacemakers andautomatic implantable cardioverterdefibrillators (AICDs) in anaesthesia.The meeting also included PBLDs and theANZCA WA Annual General Meeting.The Annual “Updates in AnaesthesiaMeeting” will be held from November 6-8,2009 again at the Quay West Resort, BunkerBay near Dunsborough in the south west ofWestern Australia. The focus of this meetingwill be trauma.From top left: Chair Dr Paul Rodoredaand Nerida Dilworth prize winnerDr Angela Palumbo; Dr Prani Shrivastavaand Dr Geoff Mullins; CPD presentation.Annual Reports – Nationaland Regional CommitteesThe Annual Reports from the Nationaland Regional Committees for the periodApril 2008 – March 2009 are published ina separate booklet distributed with thisissue of the ANZCA Bulletin.The ANZCA Bulletin June 2009 69

New Zealand newsNew Zealand Anaesthesia ASM 2009,Rotorua, November 4-7The New Zealand Anaesthesia AnnualScientific Meeting (ASM) will be held inRotorua from November 4-7 at the NovotelLakeside. This is a joint venture betweenthe New Zealand National Committee ofthe College and the New Zealand Societyof Anaesthetists (NZSA), and its NewZealand Anaesthesia Education Committee.The ASM organising committee fromthe department at Waikato Hospital hasorganised a great program. Visit the websitefor further details:www.sixhats.co.nz/nza09Call for abstractsThe call for abstracts for the free paper andposter sessions recently opened and theclosing date is 5 pm on Friday, August 7.Further details are available on the NZAASM website listed above.ANZCA New Zealand NationalCommittee (NZNC)MeetingsThree NZNC meetings were scheduledfor 2009:The first was held on Friday, March27 at the ANZCA New Zealand office inWellington. A wide range of issues werediscussed and these are described in theNZNC Annual Report which has beendistributed with this edition of the Bulletin.This report is also available on theNZNC website.The next NZNC meeting will take placebetween July 24-25. Half a day is reservedfor a joint meeting with NZSA. ANZCACEO, Dr Mike Richards, and Director ofCommunications, Nigel Henham, willvisit New Zealand during this time.A cocktail function will be held at theNew Zealand office to which the Minister ofHealth, other politicians, media and leadersof health organisations have been invited.The final NZNC meeting for 2009 will beheld on November 20. Committee memberswelcome your comments on Collegeactivities and issues that arise within theNew Zealand health system. Please contactthe New Zealand office to provide feedback.Committee membersCommittee members are elected byNew Zealand Fellows every two years.Occasionally, there is a need toco-opt members if vacancies occurbetween elections.Recently Alastair McGeorge resignedfrom NZNC due to other commitments.Alastair has served on the committeefor seven years, the first two as theNew Fellows’ representative. Thankyou to Alastair for his commitmentto the committee.Training and examinationsClinical Teachers Course workshopsAn invitation to attend these coursesis open to all Fellows, especially thoseinvolved in training. The College coversthe associated costs.The topic for the next workshop on theSeptember 4 is ‘Assisting Trainees withDifficulties’. Registrations for this workshopare now open. Please contact Juliette Adlamat the ANZCA Wellington office if youare interested.Admission to FellowshipCouncil of the College resolved at itsFebruary and April meetings that thefollowing New Zealanders be admittedto Fellowship by Examination:February 2009Emma Jane BLAIRNZAnnick Irene DEPUYDTNZNicholas James HUTTONNZ70The ANZCA Bulletin June 2009

April 2009Stefan Andre LOMBAARDChristopher George MUNNSThomas Michael AlexanderO’ROURKEDavid Matthew RUSKAnita Lee-Ann SUMPTERCraig Geoffrey SURTEESAnthony Carl YOUNGNZNZNZNZNZNZNZWorkforce issuesDHBNZ HWIP and Ministryof Health Electives InitiativeThe DHBNZ Health Workforce InformationProject (HWIP) team has been contractedby the Clinical Training Agency (CTA) toprovide workforce forecasts to help identifythe projected medical trainee numbersrequired in New Zealand. NZNC and NZSArepresentatives met with the HWIP team onMarch 26. The methodology being used byHWIP is concerning as not all anaesthetists’work will be captured, resulting in anunderestimate of the workforce and traineesneeded. NZNC has conveyed this in writingto HWIP and referred the team members tothe ANZCA/ASA workforce report that hasrecently been published.The Ministry of Health is also seekingadvice from ANZCA regarding additionalanaesthetist numbers required forthe twenty new elective surgical unitsannounced recently by the Minister.ANZCA workforce survey and reportANZCA will be conducting a workforcesurvey and report in New Zealand in 2009and this will provide data for workforceforecasts.Rural issuesTraining rotationsANZCA is strengthening its training insmaller centres. Each New Zealand TrainingRotation includes at least one rural/provincial training centre.Division of Rural Hospital Medicineand anaesthesia trainingNZNC has been asked by the Divisionof Rural Hospital Medicine (DRHM) toappoint a Fellow (Dr Tom Watson) to siton the DRHM Board of Studies. The DRHMand ANZCA are developing a systemfor introducing anaesthesia trainingalong the lines of the Australian JCCAtraining program.For information on upcoming events,courses and CME activities, pleasevisit the ANZCA NZNC website:www.anzca.org.nzAbove: View of Wellington harbournear the New Zealand national office.The ANZCA Bulletin June 2009 71

advertisement72The ANZCA Bulletin June 2009

advertisementASURA 2009Australasian Symposium on Ultrasoundand Regional Anaesthesia20 and 23 NovemberWorkshop ProgrammeMater Mothers’ Hospital, Brisbane21 and 22 NovemberLecture ProgrammeQueensland University of TechnologyRegional AnaesthesiaSpecial Interest Group ConferenceThe Organising Committee takes pleasure in inviting you to the 2009 ASURA to be held inBrisbane from 20 to 23 November 2009. Delegates are required to register separately for theworkshop and lecture programmes.ASURA 2009 has an outstanding faculty of international and local speakers who are recognisedexperts in ultrasound and regional anaesthesia. The keynote speakers include Prof. Stuart Grant(USA), Prof. Admir Hadzic (USA), A/Prof. Colin McCartney (Canada), A/Prof. Manoj Karmaker(Hong Kong), Dr Philippe Macaire (Dubai) and Dr Michael Fredrickson (New Zealand).REGISTRATIONS OPEN 1 MAY 2009!The Registration Brochure is available at www.asura2009.anaesthesia.org.au or by contactingMs Cassandra Hargreaves E: chargreaves@fed.asa.org.au T: +61 2 9327 4022CALL FOR ABSTRACTSThe Organising Committee invites you to submit an abstract on any topic relating to the role of ultrasoundimaging in regional anaesthesia. The Committee will assess all submitted abstracts and those acceptedwill be published in the meeting Abstract Book. In addition, some submissions will be selected to partakein poster presentations. Posters will be displayed and presentations sessions scheduled throughout themeeting. A prize and certificate will be awarded for the best poster presented at the meeting.CLOSING DATE FOR SUBMISSIONS 30 JUNE 2009All abstracts must be submitted in MS Word and any photographs in Jpeg or Tiff format and emailed toMs Cassandra Hargreaves, chargreaves@fed.asa.org.auAbstract Submission Guidelines are available to download from www.asura2009.anaesthesia.org.auwww.asura2009.anaesthesia.org.auThe ANZCA Bulletin June 2009 73

advertisementHOW NEW TECHNOLOGIES ANDPRACTICES WILL INFLUENCEPERIOPERATIVE SAFETYThe Queensland Committee of the Australian Society of Anaesthetists (ASA)and Australian and New Zealand College of Anaesthetists (ANZCA) invites allmembers to attend a complimentary lecture by Prof. Mark Warner on “Hownew technologies and practices will influence perioperative safety” at theQueensland Regional offices on Thursday 10 September 2009.PROF. MARK WARNERMark Warner is the Professorof Anesthesiology at the MayoClinic College of Medicine, USA.He is also currently Dean of theMayo School of Graduate MedicalEducation and is a member of theMayo Clinic Rochester ExecutiveBoard.There are many ways to considerrisk and outcome in health care,specifically procedural practices.One perspective is to considertoday’s techniques and to contrastthem against innovations insurgery and the preoperative andpostoperative care that will beprovided in the future. For thislecture, Mark will provide a viewinto the future and discuss how thecoming changes will impact thesafety of the care that anaesthetistsprovide.EVENT DETAILSThursday 10 September 20091830-1930hrs Dinner1930-2030hrs Lecture2030-2100hrs CoffeeASA/ANZCA Qld OfficeWest End Corporate ParkRiver Tower20 Pidgeon CloseWest End, BrisbaneVisitor parking is available inthe carpark.Register for thiscomplimentary dinnerand lecture today!RSVP to Linda Cuffe by 14 Augustqldevents@anzca.edu.au F: 07 3844 0249 T: 07 3846 1233ANZCA/ASACombined CMECommittee of Queensland755ASA1934 - 2009Serving Australian Anaesthetis74The ANZCA Bulletin June 2009

advertisementPRACTICAL AIRWAYMANAGEMENTThe Australian Society of Anaesthetists invitesall members to attend a complimentary lectureby Prof. Orlando Hung from Canada on “PracticalAirway Management” at Concord Hospital inSydney on Monday 24 August 2009.PROF. ORLANDO HUNGProf. Hung is currently theProfessor of the Departmentsof Anesthesia, Surgery, andPharmacology at DalhousieUniversity. He completed hisanesthesia residency at DalhousieUniversity followed by a clinicalpharmacology research fellowshipat Stanford University.Prof. Hung’s areas of clinicaland research interest includeairway management, clinicalpharmacology, and drug deliverysystems. He served on the EditorialBoard of the Canadian Journal ofAnesthesia for the past nine yearsand is the co-author of the textbook“Management of the Difficult andFailed Airway”.EVENT DETAILSMonday 24 August 20091830-1930hrsConcord HospitalClinical SchoolMain Lecture TheatreHospital Road, ConcordVisitor parking is available viaGate 4.Register for thiscomplimentary lecture now toavoid disappointment.Places are strictly limited!7551934 - 2009ASAServing Australian Anaesthetists for 75 yearsRSVP to Cassandra Hargreaves by 14 Augustchargreaves@fed.asa.org.au or 1800 806 654The ANZCA Bulletin June 2009 75

Joint Faculty of Intensive Care MedicineDean’s MessageI recently attended the ANZCA ASM inCairns and presented the final Dean’s reportat the College ceremony. The quality ofthe meeting in terms of scientific content,organisation and collegiality was excellent.The ASM is a great showcase for the Collegeand for the specialty. It was thereforewith mixed feelings that I gave the lastever JFICM Dean’s report – some sadnessabout losing the very close association ourspecialty has had with anaesthesia, but withongoing excitement about the developmentscontinuing to lead to the opening of thenew College of Intensive Care Medicine inJanuary 2010. It should also be noted thata stand-alone ASM for the JFICM has beena great catalyst for the development of aseparate College and thanks are again due toProf. John Myburgh for this great innovationsome years ago.JFICM ASM 2009By the time you read this, the 5th JFICMASM will have taken place in Brisbane.The theme of the meeting is “Energy CrisesLarge and Small: metabolism, microbiologyand sepsis”. We are looking forward toa great scientific program, includingpresentations by two excellent overseasspeakers, Professors Annane and Kollef,together with a cast of local talent. Thirtyseven new Fellows will be presenting forFellowship and the second stand-aloneJFICM New Fellows Conference will enhancethe meeting. Over the past few years theoration has been, very ably, made bydistinguished older Fellows. The theme, ingeneral, has been one of surveying a greatcareer, together with the history of thespecialty, in a retrospective manner. Thisyear we have broken with tradition and haveinvited Dr Carole Foot, one of ourdistinguished younger fellows to give theoration, looking forward from the startof a career in intensive care medicine(see page 79).College of Intensive CareMedicine (CICM)In addition to the developments reportedon in the previous Dean’s message, I ampleased to announce that, following avote in the affirmative by ANZCA Counciland then the entire Fellowship of ANZCA,a financial settlement has been reachedbetween ANZCA and the CICM. ANZCA hasgenerously gifted $1 million to the newCollege which will enhance its financialviability. Notwithstanding this gift,Fellows of the new College will be askedto contribute to the establishment andoperation of the CICM. The various optionsto do so will be canvassed at the AGM to beheld in June 2009. It is hoped that Fellowswill support this aspect of an independentcollege with as much enthusiasm as they didlast year when discussing and voting for theconcept.Two versions of a coat of arms for theCICM have been developed under theguidance of the CICM Board and withreference to heraldry specialists. These willbe unveiled at the AGM later this monthand Fellows will be invited to vote for theirchoice. A competition will then be heldto find a suitable motto for the CICM. Thiswill be open to Fellows and Trainees andwill carry a substantial prize. It may also betimely to reconsider what we would like tobe called as specialists – “intensivists” or“intensive care physicians”?The separation working party continuesto discuss matters of interest betweenANZCA and the CICM as we work towardsfull and independent operation of CICM asfrom January 2010.Clinical component of the finalexaminationLeading on from what we’d like to beknown as, it is evident that what we doon a day to day basis is largely based onclinical acumen. We strive to be “bedside”specialists, rather than “end-of-thebed”specialists. That is why there is aparticular emphasis on clinical skills inthe final fellowship examination. Despitewidespread notification of this to traineesand supervisors of training, the performanceof candidates in this section of theexamination continues to be disappointing.The examination process has been inexistence for decades now and examiners’performances are carefully calibrated in arigorous process. Therefore the standardrequired is well-known and the assessmentprocess is robust. This is not about an ivorytower mentality. This goes to the core ofwhat we do and who we are as specialists.There must be some responsibility on thetrainees and the trainers to address thismatter. This will again be disseminated viaJFICM/CICM communications with SOTsand trainees.Annual report of activitiesA detailed annual report of JFICM activitiesfor 2008 will be distributed to Fellows at theAnnual General Meeting and this will alsobe available for viewing on the JFICM (andCICM) websites.I look forward to being able to report backon a successful ASM meeting in Brisbane inthe next issue of the Bulletin.Prof PV van HeerdenDean, JFICMPresident, CICM76The ANZCA Bulletin June 2009

Joint Faculty of Intensive Care MedicineNewsJFICM AnnualScientific Meeting 2009More than 300 registrants gathered inBrisbane recently for the fifth AnnualScientific Meeting of the Joint Facultyof Intensive Care Medicine. The meeting,based around the theme of ‘Energy CrisesLarge or Small’ ran from June 12-14 at theBrisbane Convention Centre.The local organising committee, ledby Prof Rob Boots (Convener) and ProfBala Venkatesh (Chair, Scientific ProgramCommittee) put together an interestingand stimulating program. Two renownedinternational speakers, Prof Djillali Annanefrom the Raymond Poincare UniversityHospital in France and Prof Marin Kolleffrom the Washington University School ofMedicine, USA, were supported by an arrayof local experts in their field.The Felicity Hawker Medal, for the bestcontribution by a trainee to the FormalProject Session, was this year won by DrBalu Bhaskar for his presentation “Theeffect of blood transfusion on long-termsurvival after cardiac surgery”.The conference dinner and graduationceremony was, as always, a highlightof the ASM. Thirty-seven graduandswere presented at the ceremony, andan Honorary Fellowship was bestowedupon Professor ‘Nip’ Thomson for hiscontribution to intensive care medicineand the development of the Joint Faculty.The Don Harrison Medal for the bestperformed candidate in each of theFellowship Exams, were awarded to DrEd Litton for the May exam, and Dr SaraJane Allen for the October exam. The JointFaculty of Intensive Care Medal, whichrecognises an outstanding contributionto the specialty of intensive care medicine,was this year awarded to Dr FelicityHawker, the first Dean of the Joint Faculty.The ASM was well supported by thehealth care industry, with two majorsponsors (Janssen-Cilag and EdwardsLifesciences) and 18 Trade Exhibitors.A number of satellite meetings were heldalong with the ASM, including an ANZICSCTG Research Development Day, a two dayworkshop on simulation based training, aSupervisors of Training workshop and thesecond JFICM New Fellows Conference.New FellowsConference 2009The New Fellows Conference was held fromJune 9-11 at the Hyatt Regency in Coolumthree days immediately prior to the AnnualScientific Meeting.The Conference was attended by12 Fellows, each within three years ofFellowship, and an organising committeecomprised of three Fellows from theprevious year’s Conference. Topics coveredincluded leadership and negotiation skills,dealing with difficult colleagues, how to runan Intensive Care Unit, ANZICS and ruralintensive care. A 20/20 style summit wasalso held and generated a lot of discussionand ideas on the future of intensive care.From the positive feedback received itwas evident that the Conference providedan opportunity for new Fellows to discusscommon issues encountered, and to receiveexpert advice from those with many yearsof experience.From top: 2009 Graduation Fellows;Professor Bala Venkatesh - Chairmanof Examinations; Orator - Dr Carole Foot;International Speaker - Dr Djillali Annane.The ANZCA Bulletin June 2009 77

Joint Faculty of Intensive Care MedicineNewsContinuedJFICM FellowshipExam May 2009On Wednesday May 27, 2009 the generalfellowship examination commenced at theMercure Hotel in Brisbane. The Wednesdayof exam week is dedicated to the examiners’workshop, aimed at analysing preparedquestions to provide candidates with thebest possible questions.The Royal Brisbane and the PrincessAlexandra Hospitals were selected for the“hot case” section of the examination.This section comprises two ICU cases of20 minutes in duration and usually focuseson a clinical problem.The examiner dinner was held at theRiver Canteen on Brisbane’s picturesqueSouthbank, proving to be the perfect settingto farewell Professor John Myburgh from theExaminer’s panel after 12 years of service.He was presented with a certificate ofappreciation and a gift on behalf of theJoint Faculty for his wonderful service.The examination concluded onFriday with the cross table viva section.Comprising eight active stations, thissection is designed to test a large range ofintensive care related topics with 10 minutesat each station. Again, the logisticalrequirements were testing and kept JFICMstaff on their toes with a high number ofcandidates filtering through each stationfrom 8am.Following the exam, marks were checkedand the Court of Examiners confirmed18 of the 36 candidates had successfullycompleted the examination. The successfulcandidates were then presented to theCourt of Examiners for celebratory drinks.The focus now turns to Sydney for theOctober exam, where a higher numberof candidates are expected to present.This, in conjunction with the PaediatricFellowship Examination two days earlier,will make for another exciting week forexaminers and staff.Top: The JFICM Fellowship Court ofExaminers.Bottom from left: Professor BalaVenkatesh, Professor John Myburgh,and A/Prof Robert Young.Joint Faculty ofIntensive CareMedicine Board,June 2009At the close of nominations for electionto the JFICM Board, there were twonominations received for the two vacantplaces. Dr Bruce Lister was returned for afurther three year term on the Board andDr Amod Karnik was elected to the Board.The JFICM Board is now constitutedas follows:DeanPeter Vernon van Heerden, Western AustraliaVice-DeanJohn Alexander Myburgh, New South WalesEducation OfficerPeter Thomas Morley, VictoriaCensorRoss Callum Freebairn, New ZealandChairman of ExaminationsBalasubramanian Venkatesh, QueenslandChairman, Hospital AccreditationCommitteeRichard Priestley Lee, New South WalesNew Fellows RepresentativeNicole Blackwell, QueenslandElected MembersCharles Frederick Corke, VictoriaBruce Gregory Lister, QueenslandGavin Matthew Joynt, Hong KongAmod Karnik, QueenslandAppointed Member (from ANZCA)Arthur Barry Baker, New South WalesCo-opted RepresentativesAllan Beswick, TasmaniaMichael O’Fathartaigh, South Australia78The ANZCA Bulletin June 2009

Joint Faculty of Intensive Care MedicineHonorary Fellowship:Prof Napier Maurice ThompsonHonorary Fellowship of the Joint Facultyof Intensive Care Medicine, conferred atthe JFICM Annual Scientific Meeting on 13June 2009 to Napier Maurice ThompsonUnder the regulations of the Joint Facultyof Intensive Care Medicine, Australian andNew Zealand College of Anaesthetists andRoyal Australasian College of Physicians,the Board may confer Honorary Fellowshipof the joint faculty on distinguished personswho are not practising intensive caremedicine in Australia or New Zealand buthave made a notable contribution to theadvancement of the science and practiceof the specialty. Professor Napier MauriceThompson is such a man. His contributionhas lasted for many years and has beenintegral to the growth of our specialty.Professor Thompson, known as “Nip”by his friends and colleagues, was born inSouth Australia on the 8th June 1944. Hegraduated from the University of Adelaidemedical school in 1966 and completedhis physician training with the RoyalAustralasian College of Physicians in 1970.He completed his Doctor of Medicine at theUniversity of Adelaide in 1976 after workingas a research fellow in Paris and Londonfrom 1972-1975.Thereafter, Nip began an illustriouscareer that encompasses the triad of clinicalmedicine, research and education thatcontinues to this day.His consultant clinical career in renalmedicine spans nearly thirty years andcommenced as an honorary consultantnephrologist at Geelong Hospital in 1981 tothe present where he is Professor and headof the Department of Medicine of MonashUniversity and director of Renal Servicesat the Alfred Hospital in Melbourne. He hasmade a considerable contribution to theclinical advancement of peritoneal dialysisand treatment of glomerulonephritis, organdonation and renal transplantation.Nip’s research career has mirrored hisclinical one, focused on aspects of renalmedicine and transplantation. He haspublished widely in aspects of laboratoryand clinical research in three books, 26book chapters and over 140 original journalarticles. Aspects of his research includecellular and immune mechanisms of renalrejection, diabetic nephropathy, renaland pancreatic transplantation. He is therecipient of numerous research grants frombodies such as the National Health andMedical Research Council and AustralianKidney Foundation. He is a sought-afterspeaker at international and nationalscientific meetings including visitinglectureships across Australia and NewZealand, the United Kingdom, Malaysia,Singapore, Sri Lanka and China.Nip has made a tremendous contributionto medical education at all levels includingtutoring for basic and advanced physiciantrainees, co-ordination of training programsat hospital, state and national levels,supervision of doctoral and post-doctoralstudents and fellowship examinations. Hehas provided long and dedicated service tothe Royal Australasian College of Physicianssince 1980 and served as President from2006-2008. In addition, he has held seniorportfolios on the Medical Council ofVictoria, Australians Donate, the AustralianKidney Foundation and the Centre forClinical Studies.In recognition of his contribution torenal medicine, Nip has received honoraryfellowships from the colleges of physiciansin London, Ireland, Singapore, Thailandand Ceylon.But we honour him now for his greatcontribution to intensive care medicine,which has not only been through his clinicaland academic career in renal and transplantmedicine, where the two specialitiesintersect, but also in his activities relatingto intensive care medicine within the RoyalAustralasian College of Physicians.Nip served on the specialist advisorycommittees for intensive care medicineprior to and after the training programs ofthe Royal Australasian College of Physiciansand Australian and New Zealand Collegeof Anaesthetists were amalgamated.This major unifying step resulted in theestablishment of the Joint Faculty ofIntensive Care Medicine in 2002, followingwhich Nip served as the Royal AustralasianCollege of Physicians representative onthe Board of the Joint Faculty of IntensiveCare Medicine until 2008. During this period,Nip brought expert wisdom and knowledgeborne of many years of service to medicine.Moreover, Nip provided balanced, butenthusiastic support as the Joint Faculty ofIntensive Care Medicine moved inexorablytowards independence and the formation ofthe new College of Intensive Care Medicine.His role in positively supporting theinaugural Annual Scientific Meeting of theJoint Faculty of Intensive Care Medicine in2005 was an integral factor in the success ofthis meeting that is all too apparent tonight.Nip is a true “all rounder”: a dedicatedfamily man and proud father, an excellentclinician, researcher and teacher and adedicated physician to the science and artof Medicine. It is therefore most fitting that,at the last Annual Scientific Meeting of theJoint Faculty of Intensive Care Medicinebefore we meet in Sydney next year forthe inaugural meeting of the new Collegeof Intensive Care Medicine, we honourNip for his tremendous contributionduring this journey of transitiontowards independence.Professor John MyburghVice DeanJoint Faculty of Intensive Care MedicineThe ANZCA Bulletin June 2009 79

Joint Faculty of Intensive Care MedicineJFICM Medal:Dr Felicity Helen HawkerThe award of the JFICM Medal to FelicityHelen Hawker, presented at the 2009Annual Scientific Meeting.The Joint Faculty of Intensive Care MedicineMedal was established in 2005 and wasfirst presented at the inaugural JFICMAnnual Scientific Meeting that year. Thesole criterion for its award being that therecipient has made an outstanding andmajor contribution to the specialty. It isthus very fitting that Felicity Helen Hawkeris to receive the JFICM Medal at the last ASMof JFICM. Fitting because of her enormousand continuing contribution, fitting becauseof the unique nature of that contributionand also that she was the first Dean of theJoint Faculty.Like many famous Australians she wasborn in Tasmania and it was apparent fromher university and school days that she wasgoing to make a mark on the world. Ourspecialty is very fortunate that she choseintensive care medicine and she chose tolead and help guide the development ofour specialty. She was dux of her schooland first in her year at the University ofTasmania, and a champion horsewomanand winner of many academic andsports prizes.After completing her universitydegree, she gained diverse anaesthesiaand intensive care training in Hobart,Melbourne, Glasgow and Sydney, gainingEnglish and Australian fellowships beforetaking up a position at Royal PrinceAlfred Hospital in Sydney as an intensivecare specialist. There she was known forher clinical skills, academic ability andconsideration of patients, families and allmembers of the ICU team.After 10 years as co-director of ICU atRPA, she moved to Melbourne in 1995to become the director of ICU at CabriniHospital, perhaps somehow related to herblossoming relationship with a Melbournesurgeon, whom she later wed and whosecareer has many parallels with hers. Theyhave a son Paul, an extended family andvery full lives in and out of medicine.It is difficult to do justice to Felicity’sextensive career achievements, and 20-pageCV, in several short paragraphs becauseFelicity has contributed at every level ofintensive care education and training fromsupervisor of training, regional educationofficer; too many committees to list, boardsand executives, the panel of examiners,education officer, Censor, Vice-Dean, Deanand now director of Professional Affairs.She was the last dean of the Faculty ofIntensive Care and the first dean of thejoint faculty, having been instrumental inbringing together the two intensive caretraining programs. In essence she has ledand contributed to more than 15 different,major appointments over 20 years, not onlyin the section of intensive care, FICANZCA,JFICIM and ANZICS but also ANZCA andFRACP and the Committee of Presidents ofMedical Colleges. For eight years she wasa council member of the Western PacificAssociation of Critical Care Medicine.During her leisure time she has editedfour publications, given more than 35invited plenary lectures, written herown classic textbook and 21 chapters ofother books as well as numerous originalscientific articles, while following her loveof horses and bringing up a family.It is apparent that Felicity has not onlyaffected the lives of many through herclinical skills and caring, but her intellect,wise counsel and capacious memory fordetail have helped to guide our professionin its growth towards an independentcollege. She has done this with humanityand humility and her very humannesshas been a beacon for trainees,particularly women.A few years ago Sandy Peake quotedone of the pioneers of ICM, Matt Spence,when he said that the success of intensivecare was dependent on a dedicated team ofyoung doctors, who should be “young men,physically able to cope with emergenciesat any time and for prolonged periods”.Matt’s model has proven to be outdatedand it is such women as Felicity and Sandywho have helped our specialty into the21st century. Hopefully work practices arebecoming more balanced and opportunitiesare available for all to achieve leadershipand academic success. This is no smallpart due to Felicity’s advocacy for aflexible training scheme that gives fairopportunities for women.Felicity has been a great role modeland many a time I have used Felicityas an example to female trainees ofthe accomplishments, enjoyment andsatisfaction that can be gained from ICUpractice. She has devoted a large part ofher very busy life to sustain and grow ourspecialty, its training program and presencein the region. She has been at the forefront,caring, transforming the profession andtaking the lead. She is an inspiration toall and a very worthy recipient of theJFICM Medal.Clinical A/Prof Richard LeeJoint Faculty of Intensive Care MedicineBoard Member80The ANZCA Bulletin June 2009

Joint Faculty of Intensive Care MedicineThe future of intensivecare medicineThis is an edited extract of the JFICMGraduation Ceremony Oration “TheFuture of Intensive Care Medicine inAustralia and New Zealand” by Dr CaroleFoot, staff intensive care specialist,Royal North Shore Hospital.What does the future hold for intensivecare medicine? I’m going to focus on whatI see as the three most importantand interlinked areas: technologicaldevelopments that will influence how wepractice, the nature of critically ill patientsand the implications for the intensivecare workforce.TechnologyICU environmentWhat will our ICUs look like in theyears to come? We are already seeing theresults of exciting major design changes.For patients, more comfortable andpressure-easing beds that enable easypositional changes are entering the market.Access to natural light that facilitatesrestoration of circadian rhythms, a trendtowards single rooms that offer greaterprivacy and reduced risks of cross-infection,noise-reducing and mood- enhancingdecors, personal entertainment systemsand more comfortable facilities for relativesare some of the staples of new ICUs.Wireless technology is expanding andI think the spaghetti-like tangle of cablesfrom patients monitoring systems willsoon become a thing of the past. Advancedcomputer networking with more powerfulplatforms and improved user interfaces,offer the promise of more efficientmonitoring and record keeping,decision support and availabilityof reference materials.ResearchI am hopeful that basic scientists willhelp us understand and potentiallymanipulate cellular systems that influencesurvival and assist in prognostication.It will become clearer why some patientsappear remarkably resistant to criticalillness and yet others equally fragile.We are already starting to understandsome of the genetic polymorphismsthat control the inflammatory responseinfluencing the outcome of septic shockand ARDS.New drugs and equipment will comeand go. We must continue to ensurethat they are evaluated in an ethical andscientifically robust manner that can bebest achieved by being part of the process.We must inspire, mentor and supporta generation of ICU basic and clinicalresearchers who will push the envelopeof our knowledge. This will not be easy asscarce resources are stretched, but creativeways of funding this must be pursued.Co-operative relationships that cross theborders of institutions, specialties anddisciplines will foster synergism andefficiency that isolated silos cannot achieve.TeachingAs multimedia technology changes ourdaily lives, the opportunity to blend new,sophisticated learning platforms withtraditional medical educational pedagogyis truly electrifying.Borrowing from aviation, medicalsimulation is here to stay. Its role is beingincreasingly defined as evidence mountsthat it is a reliable and well-receivedmethod of teaching and assessing technicalskills, as well as team crisis management.I feel extremely strongly that we must notunderestimate our common sense whenevaluating how to incorporate simulationinto our ICU training programs. Practice canmake perfect, patients should not be guineapigs and doctors and nurses who worktogether every day should train together. Inthe future the insights and understandingthat this will bring will make us moreeffective as well as cohesive.Screen-based simulation is only inits infancy but is likely to come into itsown over the coming years as computerpower and bandwidth expands. Virtualworlds such as “Second Life” are beingincorporated into university teaching forother disciplines and healthcare is catchingup. Second Life is a 3D on-line environmentwhere users can socialize, connect, explore,learn and create using voice and text chat.There have never been so many methodsavailable for communicating informationto our trainees and with each other.Social networking sites such as Facebook,Podcasts, Blogs and Wikis are the preferredmedium for exchanging information for anincreasing number of people.These new developments are a challengefor older clinicians who did not grow upwith and become comfortable with thesemodalities. I am one of these. I am an adultof the email generation and student of thetextbook and yet I feel strongly that failureto embrace these new technologies risksopening up a communication chasm andmissed opportunities. Although there aremany unanswered questions, includinghow to control the quality of informationexploding in the virtual world, I feelstrongly that we must not be neo-luddites- resistors of new technology!PatientsThe wave of obesity sweeping westerncountries is no small matter! Australia isnow the fattest nation in the world. Weare already seeing the consequences ofthis problem in our ICUs, with the needfor bariatric equipment and increasingadmissions of morbidly obese adults.This trend is predicted to increase overthe coming years.Competing for these beds is a waveof elderly patients. Like many countries,the Australian population is ageing as aresult of unprecedented improvementsin healthcare. The ANZICS database tellsus that the number of intensive care daysprovided to patients over 70 has beenincreasing by around 14% per annum. Thisis not surprising as over the last decadepapers reporting excellent ICU outcomescan be found for older patients with a rangeof admission diagnoses and organ failures.Addressing the difficulties of ICU triage,particularly for chronically ill and elderlypatients, is beyond the scope of this talk.I strongly believe, however, that regardlessof clarifying the best candidates for ourcare, the pressure on hospital and ICUbeds will only increase and resources arealready stretched.Our emergency medicine colleaguesconstantly struggle with access block andambulance ramping on a daily basis and inthe ICU I am starting to see exit block, wherethe hospital is so full that ICU patients nolonger needing our care remain in our unit.As an example of this I recently worked withan endocrinologist in managing a younggirl with her first diagnosis of DKA fromadmission right through to discharge homefrom our ICU. The situation is exacerbatedThe ANZCA Bulletin June 2009 81

Joint Faculty of Intensive Care MedicineThe future of intensivecare medicineContinuedby the need to isolate a growing numberof patients colonized with multi-resistantorganisms and a lack of isolation facilitieson the wards.Television and increasingly the Internet,also continue to set expectations that can bedifficult to emulate in real-life, particularlywhen the realities of resource constraintsare factored into the equation.The demand for HDU care is boomingwhere I work. I believe that this also reflectsmajor resource constraints that those whopractice on hospital wards are experiencing.Specifically, a lack of experienced nursingstaff is threatening the capacity for sickpatients to be cared for out of ICUs. We musttherefore support our non-ICU colleaguesin their quest for resources; doctors, nurses,social workers and therapists, as our goalsare inexorably intertwined.If we are to continue to meet theexpectations of patients and their familiesthen it seems inevitable that societywill need to have its eyes opened to thelimitations of resources that we face on adaily basis. It appears unavoidable that theopportunity costs of providing intensivecare will need to be openly deliberatedagainst infrastructure, education, defenseand the environment and compete withother forms of healthcare for the budget.WorkforceSo how will we rise to meet these manychallenges? In a nutshell, I believe thatthis rests on cultivating a committedworkforce of intensivists with a diversityof complementary skills led by strong,inspirational leaders.Management and Leadership trainingSo what skills am I talking about?There is a rapidly evolving body of evidencesupporting the need for managementand leadership training for healthcareprofessionals and recognition that thisneeds to be tailored to transition pointsin a doctor’s career. I believe that this isabsolutely true as I qualified as a consultantfeeling well trained and yet in retrospectI had no idea of the traps and difficultieswaiting for me as a new consultant.Thirsty for new survival skills, I recentlycompleted a full-time MSc in internationalhealth management at the Imperial CollegeBusiness School in London and found it anabsolute revelation. I am constantly seeingthe relevance in my daily work of subjectssuch as organisational culture, negotiationand conflict management, project andstrategic management, change managementand health policy and finance.If we are to meet the challenges of thefuture we need to have additional skillsthat transcend patient care. We mustunderstand management speak and beable to converse with and engage hospitalmanagers to our cause. We need intensiviststhat aren’t afraid of being political and havethe skills to be eloquent and look beyondthe needs of their individual patients tothe needs of critically ill Australians andNew Zealanders. We need intensivists whowill engage in making the new college asuccessful and powerful body. We needIntensivists influencing government policyand being part of a strong internationalprofessional community.LeadershipI am grateful to have worked and continueto work with a number of extraordinaryleaders - competent clinicians, providersof vision, embracers of change andresponsibility, humanistic, approachableand supportive people who can bring outthe best in their teams - individuals whoallocate resources fairly and inspire kudossuch that teachers, researchers and thosethat perform the bulk of the administrativeduties all feel equally valued and part ofsomething special.It is a tall order but absolutely necessaryto have people such as this running ICUs.In the future, leaders and team memberswith high levels of emotional intelligencewill position themselves to recognize andmanage their own and others’ personalstrengths and weaknesses. The mosteffective teams will be those who canunleash their combined skills on difficultclinical and political problems. These traitswill help us to mitigate conflict and stress,foster innovation, career satisfaction andlongevity, and position us for tackling thechallenges of the future.Work-life balanceFor the first time in history there arefour generations in the workforce. Inthe audience tonight I see so calledTraditionalists, Baby-boomers, GenerationXs like myself and Gen Ys. Various attitudesto life and work have been attributed toeach generation. My generation for exampleis described as skeptical of authority andvaluers of work-life balance.Perhaps it is therefore predictable that Ibelieve that in the future, work-life balanceneeds to be given greater emphasis by ourspecialty if we are to consistently perform atour best and attract the best and brightestfuture intensivists. We must not ignore thefact that health professionals as a groupare vulnerable people with well-knownincreased risks of divorce, substanceabuse and suicide. We must monitor ourown behaviour, observe and support ourcolleagues in achieving their own healthyhabits and as a profession advocate forsustainable working practicesand conditions.ConclusionI hope that I have convinced you that thefuture of intensive care medicine will nodoubt be exciting as well as daunting. Itis somehow fitting that the topic of thismeeting is “Energy crises large and small”.Meeting the many challenges facing ourspecialty will take great energy!But on this account I am not worried.I believe that it is from our patients that wewill find an unlimited source of inspirationand energy that will no doubt sustain ourprofession. I have also watched manytalented and energetic young intensivistsin their academic robes traverse this stagetonight. Over the last week I have engagedwith a selection of the most motivated newfellows imaginable at the New FellowsConference in Coolum. I see the future intheir eyes, the eyes of my trainees and I seeunlimited energy before me as I look outinto this audience.For we are the future – the future is us!Dr Carole FootStaff Intensive Care SpecialistRoyal North Shore Hospital82The ANZCA Bulletin June 2009

Faculty of Pain MedicineDean’s MessageThis has been a busy period. In the lastmonth I have attended the Australian PainSociety Annual Conference in Sydney andas part of this conference, Milton Cohenchaired a public forum on “Health careservices for people in pain: when there is awill there is a way”, which was facilitatedby John Quintner. A number of our Fellowswere involved on the panel.There was also the first face to faceof the National Pain Summit (steeringcommittee) chaired by Michael Cousins.A preliminary leaders meeting was held atANZCA House on June 5 where a detailedframework for the summit was agreed.At the beginning of May I travelledto Cairns where we had three visitorspresenting at both the Refresher CourseDay (“Unravelling the Chaos of Pain”) onMay 1, then as plenary speakers in the mainANZCA ASM program. Professor AndrewRice from London, our FPM ASM Visitor,was an incredibly dedicated visitor. Hepresented outcomes of his clinical researchand also gave us clinical guidelines formanaging peripheral neuropathies. Hepresented the Michael Cousins Lectureon the Saturday morning “CannabinoidAnalgesia – Future Friend or Dead End?”stressing that although cannabinoidreceptors seem to have a very important rolein pain management, because of the riskof mental illness including acute psychosisand long term risk of psychosis andschizophrenia, we cannot recommend theiruse clinically.Andrew attended all the sessionsover the two days of the Pain Medicineconference and was a great contributor,asking questions and participating. He andI then went on to Brisbane for the RoyalAustralasian College of Surgeons meetingwhere Leigh Atkinson had organised athree-day pain and neurosurgical program.Once again Andrew Rice and several of ourFellows were able to present to the surgeonsour understandings of the risks andmanagement of chronic pain problems.Our second visitor, Associate ProfessorSteve Passik from New York, challengedhis audience at both the Refresher CourseDay and ASM, introducing the term “TheChemical Coper” to describe a patientwho is on opioids but not benefitingfrom that prescription. He also presentedthe Queensland Pain Medicine Visitor’sLecture, talking about “Risk Management inOpioid Therapy”. This talk was particularlychallenging to our anaesthetic colleaguesas he pointed out that not all opioids arethe same. Due possibly to their receptorproperties, some opioids are muchmore likely to lead to dependency in“vulnerable” patients.We once again welcomed ProfessorRollin (Mac) Gallagher as our special guestand he presented to our Board meetingon the Thursday, and then again at ourRefresher Course Day and as part of ourASM program on the weekend. Mac wasalso an active contributor in all partsof the program.At the Faculty Dinner on the Fridaynight we farewelled Roger Goucke andMilton Cohen, who have now retired fromthe Faculty Board, and thanked themfor their amazing contributions. We alsoacknowledged Professor Tess Cramond inher retirement.On Sunday, May 3 we held our AnnualGeneral Meeting followed by the new Boardmeeting and were pleased to welcome RayGarrick and Guy Bashford as new membersof the Faculty Board.Milton Cohen has taken up the challengeof being senior editor for our journal, PainMedicine, and Professor Gallagher hasencouraged the Faculty to put forward thenames of other Fellows in Australasia whoare prepared to work on the editorial boardin different capacities.I am pleased to say that more and morewe are being asked as a Faculty to commenton many different issues, and I believe itis important for us to continue to strive toprovide input so that we continue to raisethe profile of Pain Medicine. To this end,occasionally I will ask the executive officer,Helen Morris, to approach Fellows to makecomments on submissions I receive onbehalf of the Faculty.It was pleasing to welcome ProfessorMaree Smith and Associate ProfessorMichael Nicholas as Honorary Fellows ofour Faculty at the College Ceremony inCairns. Both of these individuals havecontributed to the Faculty over many years.Dr Michal Kluger FANZCA (New Zealand)was elected to Fellowship at the BoardMeeting on April 30. We now number265 Fellows (108 by examination). Threeindividuals have been directed towards thenew summative assessment pathway toFellowship without further training.Once again I would like to thank theBoard for their support and wisdom, HelenMorris and her staff, Angela Boolieris andPenny McNair for all their support and allthe Fellows that contributed to the Facultyin so many ways.Dr Penelope BriscoeDeanThe ANZCA Bulletin June 2009 83

Faculty of Pain MedicineNewsNew Faculty BoardThe new Board met on May 3 and welcomednew board members Dr Raymond GarrickFRACP and Dr Guy Bashford FAFRM (RACP),both from NSW. As Western Australia andTasmania were not represented on theboard following the recent board election,the Board resolved to co-opt the interimchair of the newly-formed WA RegionalCommittee, Dr Eric Visser, to the Board andto invite a Tasmanian Fellow to observea Board meeting later in the year.Establishment ofthe FPM WA RegionalCommitteeAt a recent meeting of WA Fellows, it wasunanimously agreed to form a Faculty ofPain Medicine Western Australia RegionalCommittee.The interim committee comprises:Chair: Dr Eric Visser FANZCASecretary: Dr Max Majedi, FANZCATreasurer: Dr Philip Finch, FRCAMembers: Dr Stephanie Davies, FANZCADr Jenni Morgan, FANZCAAnnual ScientificMeetingThe Faculty of Pain Medicine (FPM) Dean’sPrize/Free Papers session was held onSunday, May 3 at the ASM and includedseven presentations. The Dean’s Prize isawarded for original work judged to bethe most significant contribution to painmedicine and/or pain research presentedby a trainee, or a Fellow within eight yearsof Fellowship. The winner receives a grantof $1000 for educational or research papersand a certificate. Free paper presenterswho are not eligible for the Dean’s Prize areconsidered for a Best Free Paper Award andare awarded a certificate.The 2009 winners were announced at theFaculty Annual General Meeting:Dr Paul Wrigley (NSW): winner of theDean’s Prize for the research paper “BrainAnatomy Changes Associated with ChronicNeuropathic Pain Following Spinal CordInjury”.Dr Jane Trinca (VIC): winner of the BestFree Paper Award 2009 for the researchpaper “Knowledge of Pain in Recent MedicalGraduates in a Large Teaching Hospital1998-2008. Have we Made a Difference?”.National Pain SummitThe National Pain Summit is a vitallyimportant health policy initiative ledby an alliance of pain specialists,primary healthcare professionals andconsumer representatives. The proposalfor the summit was initiated by the PainManagement Research Institute (PMRI) incollaboration with the MBF Foundation.The purpose is to elevate chronic painas a significant issue on the politicaland healthcare agenda, leading to majorbenefits to consumers and ultimately, morecost-effective healthcare solutions. Thesummit is seen as a first step in progressingsome of these recommendations.FPM and the Australian Pain Societyhave also been approached to formallysupport the summit and contribute towardsits organisation. It is proposed they willalso assume leadership for taking proposalsforward from the summit, in collaborationwith the consumer group, ChronicPain Australia.84The ANZCA Bulletin June 2009

Faculty of Pain MedicineOrganisationA Summit Steering Committee has beenformed. It comprises representativesfrom all of the relevant pain managementdisciplines, GPs and other primary healthcare providers. The consumer group,Chronic Pain Australia, is also participating,as are representatives from Arthritis NSWand the Cancer Council. The steeringcommittee has held three meetings andhas agreed on a number of objectives.Preliminary Leaders MeetingIn order to prepare for the summit anddefine the outcomes required, a LeadersMeeting was held at ANZCA House onJune 5 to develop key proposals (policyrecommendations) to be presented forvalidation to a wider audience during thesummit. This meeting involved members ofthe steering committee and key stakeholdergroups such as the Cancer Council,Palliative Care Australia and the bodiesresponsible for registration and educationof relevant professional healthcare groups.Fellowship trainingand examinationdates for 2009Examination datesNovember 25-27, 2009Royal North Shore Hospital, Sydney, NSWClosing date for registrationOctober 9, 2009Admission toFellowship of theFaculty of PainMedicineBy training and examination:Dr Pamela EcclesDr Charles Chul-Han KImBy election:Dr Michal KlugerSAVICNZPhotos from the ANZCA Annual ScientificMeeting, CairnsTop row from left:Dr Jane Trinca, winner of the Best Free PaperAward with Dean, Dr Penelope Briscoe;A/Prof Steven Passik (FPM Queenslandvisitor), Prof Rollin M Gallagher (FPM specialguest), Ms Helen Jones (Janssen Cilag), ProfAndrew Rice (FPM ASM Visitor and Dr JasonRay (FPM Convenor);Dr Jason Ray (FPM Convenor) with Dr StevenPassik (FPM Queensland Visitor);FPM Dinner under the stars;Retiring board member, Dr Roger Goucke atthe unveiling of the Past Dean’s portrait;FPM refresher course at the Hilton.Bottom row from left:Dr Paul Wrigley, winner of the Dean’s Prizewith Dean, Dr Penelope Briscoe;Retiring Board Member, A/Prof Milton Cohenand Mrs Pam Cohen;Prof Tess Cramond (centre) receives astanding ovation at the FPM Dinner;Dinner speaker A/Prof Jamie Seymour (centre)with Dr Penelope Briscoe and Dr David Jones;Retiring board members Dr Roger Goucke andA/Prof Milton Cohen;Prof Michael Cousins and Dr Penelope Briscoepresent Prof Andrew Rice (FPM ASM Visitor)with the Michael Cousins Lecturer certificate.The ANZCA Bulletin June 2009 85

Faculty of Pain MedicineInaugural meetingof FPM PsychiatristsWhen the Faculty of Pain Medicine (ofthe Australia and New Zealand College ofAnaesthetists) was established in 1998, fourpsychiatrists were among the 30 FoundationFellows. Now with about 250 Fellows, thenumber of psychiatrists within the FPM hasrisen to 14.For the first time since the establishmentof the FPM, a meeting of the psychiatristFellows was held in Sydney on April 6,2009. Attendance of interstate colleagueswas facilitated by the coincident annualscientific meeting of the Australian PainSociety. Impressively, 11 of the 14 Australianand New Zealand FPM psychiatristsattended a dinner during which a broadrange of pertinent issues was discussed. Itwas a rare privilege to gather with such agroup, to be able to put faces to people withwhom one has liaised over the years and tomeet afresh other colleagues working in thischallenging field.Against the splendid backdrop that isDarling Harbour’s city light show, an arrayof significant issues pertaining to psychiatryand pain medicine was explored.Several priorities were identified. Theseincluded raising the profile of psychiatrywithin the Faculty of Pain Medicine, andof the Faculty of Pain Medicine within theCollege of Psychiatry (RANZCP). Thoughtwas also given to our relationships withallied groups such as addiction medicineand rehabilitation medicine.At a more specific level the groupconsidered it important that the knowledgebase regarding pain management issues beraised in medical undergraduates, generalpsychiatry trainees, specialist CL traineesand the broader fellowship of the RANZCP.Ultimately, it would be hoped that morepsychiatrists will be attracted to Fellowshipof the Faculty of Pain Medicine and avenuesfor promoting this were discussed.There was some discussion regardingthe possibility that we establish a specialinterest group (SIG) within the RANZCP’ssection on consultation/liaison psychiatry.The same consideration was also givento forming a SIG in the Faculty of PainMedicine. On a broader, global setting, thethought of establishing a SIG for psychiatrywithin the International Association (IASP)received a great deal of interest fromthe group.86The ANZCA Bulletin June 2009Several decisions were made at themeeting. First, it was agreed that the groupwould meet informally whenever therewere sufficient numbers at a conference ofinterest, but formally on an annual basis.There was some significant discussion asto whether the meeting should be attachedto any specific conference, and if so which,without a clear decision having beendetermined. It was agreed that, as the nextmeeting of the Australian Pain Society willbe conjoint with the New Zealand PainSociety, it would be an appropriate time tobring this trans-Tasman group together onceagain, a yearor so hence. The agenda for that meetingwill include the need to determine thetiming of future meetings.It was also agreed that the group wouldendeavour to coordinate a formal academicsession at each and every future congressof the RANZCP, for our own academicdevelopment and of our colleagues.A letter is to be written to the chairmanof the board of education of the RANZCPto enquire about the prominence of painmedicine within the training curricula, andto offer involvement of the group in thisregard. Members of the group indicatedtheir acceptance that ideally, each of usshould forge closer relationships with ourCL colleagues; it was noted that manyof us are employed by departments ofanaesthesia/pain management rather thandepartments of psychiatry and that thismight have facilitated some of us drifting alittle from our colleagues.At an even more practical level, muchdiscussion was held about the potential forFPM psychiatrists to become more involvedin undergraduate as well as FellowshipExaminations for both the FPM and theRANZCP. Fellows with ideas upon whichthey might develop model answers shouldcontact Frank New or George Mendelsonbefore putting too much effort into this,to ensure that they’re not re-inventingsomething that is already on file.The evening ended with a pervasivesense that this had been an importantevent, with a sense of satisfaction that aprocess had been set in train which willultimately benefit ourselves as well as ourprofessional and broader communities.Dr Newman HarrisConvenorHIV and NeuropathicPain SeminarFellows of FPM in Melbourne and membersof the Australian Pain Society, meetingas The Victorian Pain ManagementGroup, were treated to a fascinatingseminar on May 14, 2009 hosted by theBurnet Institute at the Alfred Hospital inMelbourne. The topic of discussion wasHIV and neuropathic pain, with a seminarappropriately titled “Touching a RawNerve”. Professor Andrew Rice, (FPMASM visitor, 2009) from Imperial CollegeLondon was joined by a local luminary onneuropathic pain in HIV, Dr Kate Cherry,who is head of Neuropathy and DrugToxicity (HIV) Research at the BurnetInstitute in Melbourne.Many Fellows will have heard ProfRice speak in Cairns and be aware of hisvast clinical and scientific knowledge ofneuropathic pain. In this instance hiswork on HIV neuropathy shed fascinatinginsights into this condition, which hasfeatures different to other forms ofneuropathic pain. With an estimatedincidence of 33 million HIV casesworldwide, the problem of pain is a majorconcern. Neuropathy can occur, typicallya distal sensory neuropathy, both primary,and also secondary to antiretroviraltherapies. Of great concern was theresearch showing poor response to typicalanalgesic therapies for neuropathic pain.The speakers highlighted new researchincluding epidemiological insights, publichealth approaches, research into the resultsof phenotyping to select treatment andpotential new drug developmentsfor treatment.Dr Carolyn ArnoldAustralian Healthand Medical ResearchCongressChronic pain and its treatment: frommolecular to clinicalThe Australian Health and MedicalResearch Congress (AH&MRC) is aninitiative of the Australian Society forMedical Research and this fourth congressbrought together 33 specialist societiesand groups with the key aim of fosteringcross-disciplinary collaboration andapproaches to improving human health.

Faculty of Pain MedicineThe symposium was proposed andfinancially supported by the Faculty ofPain Medicine (ANZCA), Australian PainSociety (APS) and ASCEPT (AustralasianSociety of Clinical and ExperimentalPharmacologists and Toxicologists) and wasthe only symposium that had more than twosponsors. It was held on Thursday morningNovember 20, 2008 to a packed audience(standing room only) of over 150 registrantsand was chaired by Dr Amal Helou (APSPresident) and Prof Andrew Somogyi(ASCEPT Immediate Past President).The four speakers were:1. Prof Mac Christie (NHMRC SeniorPrincipal Research Fellow, Brain & MindResearch Institute, University of Sydney):“Molecular Basis of Pain- New Targets”.A large number of new drug targetswas discussed including TRP channels,subtypes of sodium channels andGABAA receptors, new G-protein coupledreceptors and cytokine receptors with theanticipated hope that we will see newpain-relieving drugs clinically availablewithin the next four years.2. Prof Maree Smith (Centre for IntegratedPreclinical Drug Development and Schoolof Pharmacy, University of Queensland):“Preclinical development of new drugsfor pain treatment”. Animal models withbetter predictive validity for targeted paintypes were described including rodentmodels of painful diabetic neuropathy,mechanical nerve damage pain and postherpeticneuralgia with the anticipatedhope of accelerating the transition phasefrom preclinical to initial human studies.3. Dr Luke Henderson (Department ofAnatomy and Histology, University ofSydney): “Imaging as a tool for paindetection and assessment”. Structuralbrain changes associated withneuropathic pain following spinal cordinjury and in chronic orofacial pain weredescribed with the anticipated hope of animproved diagnostic marker allowing forbetter assessment of treatment.4. Prof Stephan Schug (Anesthesiology,School of Medicine and Pharmacology,University of Western Australia): “NewClinical Developments in Pain Therapy”.Gabapentinoids, coxibs (“… an importantimprovement over non-selective NSAIDs,but regrettably not the harmless panaceaon nonopioid analgesia”), ketamineand SNRIs were discussed in terms ofadvantages and disadvantages andhighlighting that exciting new drugs arebeginning to reach clinical practice andolder ones establishing their place.Overall, there was plenty of robustdiscussion and it was clear that pain hasbeen a neglected area at these congresses.I would like to thank all the speakersand Amal Helou for making my job asco-ordinator quite easy. Perhaps weshould consider participating in the 2010Congress in Melbourne and including aninternational speaker as well.Prof Andrew SomogyiSymposium Co-ordinatorThe Faculty of Pain Medicinein conjunction with the Acute PainSIG 3rd Annual Spring Meetingin Melbourne, AustraliaThe Organising Committee extends an invitation to attendthis stimulating meeting which brings together some greatminds to address some of the most difficult problemsfacing those who treat pain.The Theme ‘Duelling with Pain’encompasses the precision andattention to detail clinicians mustembrace to win the battle withthe more complex aspects of painmanagement in many settings. Themeeting will focus on the emergingcollaborations between pain medicineand other specialties such as addictionmedicine as each brings newinformation to aid the patientwith pain.Invited speakers are; Roman Jovey,Canada, Suellen Walker, UnitedKingdom, Damien Finniss andAndrew Somogyi, Australia.This meeting brings togethera diverse group of clinicians andscientists from Pain Medicine,Addiction Medicine, Basic Science,Palliative Medicine, RespiratoryMedicine, Geriatric Medicine andTrauma and Disaster Medicine.Presentations on topics include;Opioids, New Analgesics in thePipeline, Prescribing for the Elderly,Intrathecal Analgesia – New Findingsand Improved Practice, Cancer Pain,Acute Pain, Placebo Revisited andVictorian Bushfire Retrieval.We hope you will join us in Octoberto learn and also share your ideasin the many interactive sessions.Enquiries should be addressed to:Marta Dziedzicki, Conference Secretariat, ANZCATel: (+61 3) 9510 6299Email: mdziedzicki@anzca.edu.auwww.anzca.edu.au/fpm/events/2009springmeetingThe ANZCA Bulletin June 2009 87

Faculty of Pain MedicineReport from theBoard Meetings held onApril 30 and May 3, 2009Faculty BoardThe Faculty Board met on April 30 and thenthe “new” board met on May 3 to appointoffice-bearers and committees.Strategic planningAt the April 30 board meeting, we reviewedthe progress against the last strategic planand good progress has been made with:• Curriculums to medical schools PGY 1 & 2• Increased number of training units• Regional committees in three states• MoUs signed off• A budget of $7,000 each year for threeyears for a pain program at the RACS ASC• Liaison with RACGP reorganising acurriculum for GPs• National Pain Summit up and running• Spring meetings established• Teleconferences established with APSand NZPSA half-day strategic workshop isproposed in conjunction with the Augustor October Board meetings to marry in withANZCA’s strategic review. Challenges aheadinclude:• Educating the profession and publicabout pain medicine• Education of GPs and supporting GPs todevelop a curriculum• Continuing to build the Faculty’s profile• Closer liaison with the AFRM and AChAM• Attracting young psychiatrists into theFaculty• Strengthening relationships with the APSand NZPS• Changing nature of medical practice: Selfmanagement of chronic disease/illnessRegional representationFollowing the recent Board election therewas no representation from WA andTasmania on the Faculty Board. The Boardresolved to co-opt the interim chair of thenewly-formed Western Australian RegionalCommittee to the Board. A Tasmanianrepresentative will be invited to observe ata Board meeting later in the year and willbe asked to bring ideas on how the Facultycan help raise the profile of pain medicinein that region.Relationships portfolioLiaisons with medical collegesANZCADr Leona Wilson, ANZCA President,attended the April Board Meeting andwill attend several board meetings a yearto promote communication betweenANZCA and the Faculty. Issues raisedincluded the Faculty’s desire for a strongsound relationship with the College,the reduction of FPM representation onANZCA committees and concerns that theFPM Dean, as a co-opted representative isnot a Director or included in the financecommittee. Three Board members wereinvited to attend a council workshop inApril with a facilitator from the AustralianInstitute of Company Directors and hadfound this to be very useful.RANZCOGA working group with multidisciplinaryinput from pain, obstetrics, psychologyand physiotherapy, is developing a draftdocument on pelvic pain. It is anticipatedthis will take the form of a professionaldocument or clinical update which may beconsidered for publication in the MedicalJournal of Australia.RANZCPA group of psychiatry FPM Fellows metduring the recent APS meeting. Severalpriorities were identified including raisingthe profile of psychiatry within the FPMand of the FPM within the RANZCP andcoordination of a formal academic sessionat each future RANZCP congress. The groupwill next meet at the APS/NZPS meeting in2010. A full report from Dr Newman Harriscan be found in this edition of the Bulletin.RACSFaculty Fellows and the FPM ASM Visitor,Professor Andrew Rice, spoke at the twodaypain program of the 2009 RACS ASCfollowing the ANZCA ASM. The 2010 RACSASC will be held in Perth and the painprogram is being organised byDr David Holthouse.Visitors to future Board MeetingsThe President of the Australian PainSociety, Dr Stephen Gibson, will attend theAugust Board Meeting, and the Presidentof the Australasian Chapter of AddictionMedicine, Dr Yvonne Bonomo, is to beinvited to attend in October.Liaison with pain societiesTo further improve liaisons with the painsocieties, Faculty regional committeeswill be asked to co-opt an APS member.Liaisons at a national level are to bepursued including the possibility of jointprofessional documents. A teleconferencemeeting of the Faculty, APS and NZPS isscheduled for June 3.UK pain specialtyThe Faculty of Pain Medicine of the RoyalCollege of Anaesthetists (RCA) has soughtadvice on establishing a formal assessmentprocess for the UK Faculty. They haveaccepted an invitation to send an observerto the 2009 examination in Sydney.American Board Pain MedicineProfessor Rollin (Mac) Gallagher, presidentof the ABPM, met with the board and gave apresentation on developments with the PainMedicine journal. At the new board meetingProf Milton Cohen was appointed senioreditor of Pain Medicine. Prof Gallagher alsorequested interested fellows to nominateas sub-editors.Chronic Pain AustraliaChronic Pain Australia has organisedconferences and held a well-attendedconsumer session before the APS meetingchaired by Milton Cohen, in which severalFellows participated. This organisationaims to offer a telephone advisory servicein liaison with Arthritis NSW, a successfulsupport group.Fellowship AffairsportfolioFellowshipNew admissionsDrs Pamela Eccles FANZCA (SA) andCharles Kim FANZCA (Vic) were admitted tofellowship by training and examination andDr Michal Kluger FANZCA (New Zealand)was elected to Fellowship by election. Threeapplicants were offered the new summativeassessment pathway to Fellowship whichinvolves satisfactory completion ofexamination and case report requirementswithout further training.Honours and appointmentsThe Board acknowledged and congratulatedthe following recipients:Dr Bob Boas has been awarded lifemembership of the NZSA88The ANZCA Bulletin June 2009

Dr Carolyn Arnold, A/Prof Leigh Atkinson,A/Prof David Cherry, Prof Arthur Duggan,Dr David Gronow and Prof GeorgeMendelson have been awarded AustralianPain Society Distinguished Members Awards.Continuing educationand quality assuranceScientific meetingsThe Faculty will request that a secondplenary lecture on the Sunday morning ofthe ANZCA ASM be permanently allocatedto a FPM Visitor and that an annual budgetbe allocated for a second speaker.2009 Spring meeting – MelbourneThe registration brochure for “Duelling withPain” at the Sofitel Melbourne from October16-18 has been circulated and registrationshave started. The visitor is Dr Roman DJovey (Canada). The convenor, Dr CarolynArnold, and the local organising committeewere congratulated on developing anexcellent program.2010 Spring MeetingDr Chris Hayes will convene this meetingand a theme of “Transitions in Pain”is proposed. A venue and date is yet tobe confirmed.2010 ASM – ChristchurchPlans are well advanced for a refreshercourse day and ASM program includingDr Jeffrey Mogil (Canada) as the FPM ASMvisitor and Dr Richard Rosenquist (USA)as the FPM New Zealand Visitor.2011 ASM – Hong KongDr P Chen was confirmed as the FPMconvenor for the 2011 meeting in HongKong. Professor Leigh Atkinson will bethe deputy convenor.ResearchCore outcomes databaseA research proposal is about to go to theHunter Ethics Committee for approval.Outcome measures have been agreed.Further information about the project,including opportunities for participation,will be included in Synapse.Implant registerThe board supported in principle thedevelopment of an implantable devicesregister for neurostimulation devicesand implantable Intrathecal medicationdelivery devices. This register would besimilar to ones used widely for implants inorthopaedic surgery. A sub-committee hasbeen formed to prepare a proposal beforeseeking input from the Federal Government.Regional committeesQueenslandThe Board discussed the lack of fundedpain places in Queensland public hospitals.A meeting will be convened with the ANZCAdirectors of communication and policy,quality and accreditation in conjunctionwith the August Board Meeting tobrainstorm strategies for a federal and statelevel approach.New South WalesThe NSW regional committee met inFebruary and commenced circulation ofan e-newsletter “The Algometer” http://www.anzca.edu.au/fpm/news-and-reports/nsw-regional-committees-newsletter. Threeissues a year will be circulated to NSWfellows and trainees.Western AustraliaAn interim Western Australian regionalcommittee of the Faculty of Pain Medicinehas been endorsed with the authority towork under the FPM Regional Committeeregulations with elections to be held in thefirst quarter of 2010. The interim committeecomprises:ChairDr Eric VisserSecretaryDr Max MajediTreasurerMembersFr Philip FinchDr Jenni MorganDr Stephanie DaviesProfessionalNational Pain SummitThe Board believes a National PainSummit is a vitally important health policyinitiative. The proposal for the summit wasinitiated by the Pain Management ResearchInstitute (PMRI) and the MBF Foundation(MBFF) and the purpose is to elevatepain management as a significant issueon the political and healthcare agenda,leading to major benefits for consumersand ultimately, more cost-effectivehealthcare solutions. The summit is seenas a first step in progressing some of theserecommendations.The faculty of pain medicine has beenapproached to formally support the summitand contribute towards its organisation.A summit steering committee has beenconvened. It comprises representativesof all pain management disciplines, GPs,other primary care providers. A numberof consumer group, are also participating.In order to prepare adequately for thesummit and define the outcomes required,a preliminary leaders meeting will be heldat ANZCA House on June 5, to develop keyproposals (policy recommendations), whichwill be presented to a wider audience at thesummit, for validation.Acute pain management: scientificevidence 3rd editionIn recognition of the significant amountof work put in by the editors of APM:SE3rd edition, it was resolved that approvalbe given for the editors to be listed in thispublication.Pain physicians referral to allied healthprofessionalsFollowing advice from the ASA with regardto complex pain consultations, referrals toallied health professionals and telemedicineitems, the faculty will start dialoguewith a view to making the appropriatesubmissions. It has been advised that ascheme providing access to allied healthis under review and expansionto pain medicine specialists shouldbe achievable.Trainee AffairsportfolioAssessorAs the Faculty moves toward tighteningthe amount of retrospectivity toward the“elective” year of training, more definitionof the content and how it is assessed will beincluded in the regulations. The assessoris developing a guide for retrospectiveaccreditation toward this elective period.Education committeeA focused resources document for traineesand Fellows has now been completed andis available from the Faculty website. TheANZCA library will be asked to ensure thatthey have access to the books referred to inthe document.The ANZCA Bulletin June 2009 89

Faculty of Pain MedicineReport from theBoard Meetings held onApril 30 and May 3, 2009ContinuedTraining unit accreditationFollowing a paper review after one year, theRoyal Prince Alfred Hospital in Sydney wasaccredited for the balance of the threeyear term.Resources portfolioFinanceFigures to March 31 showed the facultyto be doing well against budget.Board and committeeappointmentsBoard Members:DeanPenelope BriscoeVice Dean/assistant assessor David JonesAssessorFrank NewChair education committee Ted ShiptonChair examination committee Ray GarrickChair training unitaccreditation committee Brendan MooreChair research committee Chris HayesChair continuing education& quality assurancecommittee/CPD officer Guy BashfordTreasurer/scientificmeeting officerCo-opted memberrepresenting ANZCASenior editor Pain MedicineLeigh AtkinsonCarolyn ArnoldKerry BrandisMilton Cohen(non-boardmember)Executive committee/portfolio chairs:Chair relationships portfolio Penelope BriscoeChair trainee affairs portfolio Brendan MooreChair fellowship affairsportfolioDavid JonesChair resources portfolio Leigh AtkinsonExamination committee:ChairDeputy chairDean (ex officio)Members:AFRM (RACP)RACSRANZCPANZCANew Fellow representativeRay GarrickMeredith CraigiePenelope BriscoeCarolyn ArnoldLeigh AtkinsonGeorge MendelsonFrank NewMelissa VineyMark TadrosEducation committee:ChairDean (ex officio)Chair trainee affairsportfolio (ex officio)Chair examinationscommittee (ex officio)Members:Ted ShiptonPenelope BriscoeBrendan MooreRay GarrickMichael ButlerDirector of education, ANZCA Mary LawsonSupervisor, SoTsNew FellowrepresentativeFrank NewFaizur NooreTim SempleStephan SchugMark SchutzePeter TeddyJane TrincaOwen WilliamsonPaul WrigleyTraining unit accreditation committee:ChairBrendan MooreAssessor (ex officio) Frank NewMembersCarolyn ArnoldMatthew CrawfordDavid GronowDiarmuid McCoyDeputy SoTsMelissa VineyEric VisserPauline WaitesResearch committee:ChairChris HayesVice Dean (ex officio) David JonesSenior editor Pain Medicine(ex officio)Milton CohenSection editor Pain Medicine Colin GoodchildMembersCarolyn ArnoldGuy BashfordJulia FlemingMalcolm HoggTim PavyStephan SchugPhilip SiddallMaree SmithAndrew SomogyiContinuing education & qualityassurance committee:ChairGuy BashfordVice Dean (ex officio) David JonesScientific meeting officer(ex officio)Leigh AtkinsonImmediate past ASMconvenorJason RayASM convenorTed ShiptonSpring meeting convenor Carolyn ArnoldFuture spring meetingconvenorChris HayesMembersMilton CohenDiarmuid McCoyPeter RofeMichael VaggRepresentation on ANZCA committees:Research committee Chris HayesIMGS committee: assessor(ex officio)Frank NewRegional committees:QueenslandRichard PendletonNew South WalesKok Eng KhorVictoriaDavid ScottTasmaniaGajinder OberoiSouth AustraliaPamela MacintyreWestern AustraliaEric VisserNew Zealand nationalcommitteeDavid JonesExternal committees & organisationsAustralasian anaesthesia Robyn CampbellFaculty working parties and task forcesblueprinting sub-committee:ChairFrank NewMembersWilbur ChanTim SempleJane TrincaOwen WilliamsonAcute Pain Management:Scientific Evidence 3rd Edition:ChairPamela MacintyreMembersStephan SchugDavid A ScottSuellen WalkerEric Visser90The ANZCA Bulletin June 2009

Faculty of Pain MedicineDean’s Report to theAnnual General Meeting 2009This is the tenth year of the Faculty and47 Fellows were granted FoundationFellowship at this ceremony in Adelaidein1999. We are now proud to now number260 fellows, of whom 106 have been grantedFellowship by the examination process.At the Annual General Meeting in May of2008, the Faculty implemented a new Boardstructure, recognising its responsibilitiesnot only to its trainees but also theFellowship and to better provide support forthe progression of strategic initiatives. Fourportfolios were formed, each with a Boardmember as Chair - (Relationships myself theDean, Fellowship Affairs Vice-Dean DavidJones, Trainee Affairs Brendan Moore, andResources, Leigh Atkinson). The Chair ofthese portfolios now makes up theFaculty Executive.We also restructured the committees aswe recognised that Ted Shipton, who hadbeen Chair of the Education and TrainingCommittee, had a massive workload, andTed has continued to provide a fantasticservice to the Fellowship, but now can focuson the Education Committee role. BrendanMoore, has taken over the role of Chair ofthe Training Unit Accreditation Committee,and in the last 12 months, five hospitalshave been re-accredited for training andthe Burwood Hospital Pain ManagementCentre in Christchurch New Zealand, andthe Singapore General Hospital were alsoaccredited. We congratulate Singapore inbeing the first unit outside of Australasiato be accredited by the Faculty for trainingin Pain Medicine. There are currently 23accredited pain training unit throughoutAustralasia and now Singapore.Milton Cohen has worked tirelessly asChair of the Continuing Education andQuality Assurance Committee. The Facultyheld a second Spring Meeting in Septemberat Ayres Rock in association with the AcutePain SIG of ANZCA, the ASA and the NewZealand SA and the Acute Pain SIG of theIASP. I thank Pam Macintyre the Convenor,Stephan Schug, the Scientific Convenorand Steve Jones the Co-Convenor for theirtireless work for what we consider wasan overwhelmingly successful meeting,both financially and politically. A greatdeal of good will and enthusiasm wasgenerated between the acute and chronicpain practitioners, with recognition toimprove outcome for all our patients goodcommunication between the differentspeciality groups is essential. As a followon from that, this year’s Spring Meetingwill be held in Melbourne in October withCarolyn Arnold as Convenor, and onceagain we have had very fruitful input fromJane Trinca and other members of the AcutePain SIG.The Faculty is also very grateful to DrJason Ray for his excellent work as the 2009FPM Convenor in building an exciting andbroad-ranging Refresher Day andScientific Program.Recognising the importance ofcooperation between acute and chronicpain practitioners and the fact that notall pain practitioners can work within amultidisciplinary setting, the Board hasnow reintroduced the process where thosewho practice Pain Medicine, but who maynot meet all the requirements for Fellowshipcan apply for election to the Faculty and bedirected towards Fellowship without furthertraining by completing the case report andexamination requirements. I am hopingthis will allow some of our acute paincolleagues who perhaps do not fulfil all therequirements to apply for fellowship.We continue to receive applications to doour training from outside the five specialtiesthat formed the Faculty originally. Wenow have Fellows who have backgroundsin Obstetrics and Gynaecology, ENT andRadiology, and we currently have threegeneral practitioners undergoing ourtraining programme. This leads us to askthe question, “What is a Pain MedicineSpecialist?” Frank New is chairing aBlueprinting Sub-committee with supportfrom Brian Jolly. This group is spendingmany hours debating this question. Oncethis process is complete then we will needto re-visit our curriculum to see that the twomarry up and ensure that our trainees arecomfortable in their roles after completingthe training process.In October the Board held a workshoplooking at Board Members responsibilitiesand accountability, and this process wasfacilitated by the Australian Institute ofCompany Directors.We are a small Fellowship, but ourFellows are enthusiastic and nationally wenow have three Regional Committees; inQueensland chaired by Paul Gray, in NewSouth Wales chaired by Kok Eng Khor, and,following a meeting in Western Australia inApril, in Western Australia chaired by EricVisser. We are hoping that other states willfollow.In New Zealand, David Jones, TedShipton and Steuart Henderson are workinghard to get Pain Medicine recognisedas a specialty within that country.Internationally our association with theAmerican Academy of Pain Medicinecontinues to grow. Dr Michel Duboisthe Chair of the American Board of PainMedicine Examination Committee observedat our Faculty exam at St Vincent’s inNovember. He was very impressed with theprocess and congratulations go to Dr RayGarrick the Chair of the Exam Committee.Seven Fellows attended the AmericanAcademy of Pain Medicine meeting inHawaii where Roger Goucke was awarded aPresidential commendation and Nik Bogdukreceived a Founders Award for OutstandingContributions to the Science or Practice ofPain Medicine.We continue to try to raise the profileof Pain Medicine both across Australasiaand also in our association with our otherColleges. Leigh Atkinson continues towork tirelessly improving the standingof Pain Medicine both with RACS and inQueensland and Andrew Rice our ASMvisitor will be presenting at the RACSmeeting in Brisbane later this week.Carolyn Arnold and Jane Trinca have beenworking with a group in Victoria looking atavailability of Pain Medicine in that state.Newman Harris and Frank New have formeda group of interested psychiatrists to aim toimprove our standing.The ANZCA Bulletin June 2009 91

Faculty of Pain MedicineDean’s Reportto the AnnualGeneral Meeting2009ContinuedFaculty of Pain MedicineHonorary Fellowship:Prof Maree Therese SmithChris Hayes as Chair of the ResearchCommittee is looking at a multi-centrestudy with input from both the HunterIntegrated Pain Service and CaulfieldPain Management and Research Centrein Victoria looking at outcomes. Many ofour Fellows contribute to the Faculty in somany ways and I would particularly liketo acknowledge the tireless input of TimSemple who is on a number of committeesand is also the Supervisor of Supervisorsof Training, Melissa Viney who is DeputySSoT and also contributes to TUAC andExams,Owen Williamson works on theEducation Committee and BlueprintingCommittee as does Jane Trinca. PaulWrigley and Diarmuid Mc Coy are onseveral committees. To you all Thanks.To my Board – thank you all for yourongoing support, guidance and wisdom..But of course the Faculty could notbe possible without the support of ourExecutive Officer Helen Morris and her staff,Penny McNair and Angela Boolieris, andI particularly wish to thank them for theirfriendship, warmth and hard work.In closing, I am very excited that thisis the Faculty’s 10th year and we will beacknowledging this at the Spring Meeting inMelbourne. The Faculty is well prepared tocontinue with its unique interdisciplinarymodel moving forward to provide whatis considered internationally one of theleading Pain Medicine Faculties in theworld, both with our organisationalprocesses and certainly our trainingand examination.“The Board of the Faculty of Pain Medicineadmits from time to time distinguishedpersons who have made a notablecontribution to the advancement of thescience and practice of pain medicine,who are not practicing pain medicine inAustralia or New Zealand”.Professor Maree Therese SmithAfter obtaining a B Pharm (Hons) degreefrom the University of Queensland, MareeSmith undertook research higher degreetraining in clinical pharmacokinetics,bioanalysis and drug metabolism underthe supervision/mentorship of professorsWayne Hooper and Mervyn Eadie in theDepartment of Medicine, University ofQueensland at Royal Brisbane Hospital,culminating in a PhD degree in medicine.Following a period of postdoctoraltraining in the field of pain managementwith Professor Tess Cramond (director,Multidisciplinary Pain Centre at RoyalBrisbane Hospital), Maree was appointedas a lecturer in the School of Pharmacy atUQ in mid-1989. Over the next 15 years, shewas progressively promoted through theacademic ranks at UQ culminating in herpromotion to Professor of Pharmacyin 2004.Prof Smith has specialist expertise inpre-clinical drug development includinganimal models of human disease,bioanalytical assays and pharmacokineticsand oversees research in a broad rangeof projects focussing on improvingour understanding of the mechanisticbasis of a range of pain states and theirpharmacological management.Prof Smith is the inaugural directorof Australia’s first Centre for IntegratedPreclinical Drug Development (CIPDD) andis Professor of Pharmacy at the Universityof Queensland. In the past two decades,Prof Smith and her team have undertakenconsiderable research in the field of painpharmacology with this research directedtowards improving patient outcomes.Prof Smith has successfully supervised tocompletion 15 PhD students, two researchMasters students and 30 Honours studentsand she is supervising four PhD students,three Master of Philosophy students andthree Honours students now.In 2001 and 2002, Prof Smith received“meritorious mentions” from the Universityof Queensland in recognition of sustainedexcellence in the supervision of researchhigher degree students. In 2003, Prof Smithwas awarded a “Trailblazer Challenge”award by UniQuest, and in 2008 shereceived the Women in Technology BiotechOutstanding Achievement Award.Prof Smith’s contribution toimprovements in clinical managementof pain and to our own faculty of painmedicine is recognised today with theawarding of Honorary Fellowship of theFaculty of Pain Medicine of the Australianand New Zealand College of Anaesthetists.Dr Brendan Moore92The ANZCA Bulletin June 2009

Faculty of Pain MedicineHonorary Fellowship:A/Prof Michael Kenneth NicholasMichael Kenneth NicholasAssociate Professor Michael Nicholas wasborn in Christchurch in New Zealand, andgrew up in Cheviot, North Canterburybefore attending King’s College inAuckland. Initially completing a BSc degreein Zoology at Otago University he switchedto studies in psychology at AucklandUniversity, graduating MSc with Honours in1978. He completed his training in clinicalpsychology at the University of New SouthWales in 1980, before going on to workin the multidisciplinary pain service atWestmead Hospital from 1980-87 and doinghis PhD thesis on evaluating a cognitivebehavioural therapy program for low backpain (Sydney University, 1988).From then to now A/Prof Nicholas hasbeen a prolific worker and internationalcontributor as a clinical psychologist,researcher and educator. A/Prof Nicholasholds a conjoint hospital and universityposition at the Pain Management andResearch Institute, University of Sydney(Faculty of Medicine) and Royal North ShoreHospital and is director of the ADAPT painmanagement program.More than 80 journal and bookchapter publications can be identifiedconcerning psychological aspects of pain,its assessment and management. He hasbeen principle investigator on a number ofcollaborative research projects, includinga large NHMRC (Australian) funded RCT ofphysiotherapy for sub-acute low back pain,an Australian health minister’s advisorycouncil priority research grant to evaluatean intervention for self-management ofchronic pain in elderly Australians, anAustralian Research Council grant forattentional mechanisms in acute andchronic pain and an NHMRC project grantto evaluate psychological interventionsaimed at reducing the distressing nature ofchronic pain, and more. Very well-known inthe professional and lay community is theself-management manual for people withchronic pain, Manage Your Pain.Research on improving the return towork of injured workers has been a majorinterest, with contribution to developmentof guidelines (clinical framework) onpsychological services for injured workerswith the Victorian Workcover Authority,and similar for WorkCover (NSW) on themanagement of soft tissue injuries.In 2008 A/Prof Nicholas was awardeda visiting research fellowship at theCentre for Health and Medical Psychology(CHAMP) in the psychology departmentat Orebro University (Sweden). He wasa member of the scientific programcommittee of the IASP for the 2008 WorldCongress on Pain in Glasgow, and recentlyinvited to the editorial board of Pain, aleading international pain journal. He isalso a regular reviewer for 15 national/international professional andscientific journals.A/Prof Nicholas has pointed out thatwith a future ageing population and abouta quarter of elderly people suffering someform of chronic pain, it will be essential tolook at ways to help the elderly. His lecturetopics include descriptions of commonbarriers that hinder rehabilitation, andways to tackle challenging pain obstacles.Among what he considers his personalbest achievements he lists helping indevelopment of pain programs in SouthEast Asia, London and throughoutAustralia. Personal traits of reflection,persistence and patience, with an interestin others and open discussion have carriedhim through the gigantic tasks that he hasset himself, past and future.By many direct and indirect meansA/Prof Michael Nicholas has helped lessenthe suffering of those in pain. The awardof Honorary Fellowship of the Faculty ofPain Medicine is a fitting recognition of thesubstantial contributions A/Prof Nicholashas made in the broad field of our specialty.Dr David JonesThe ANZCA Bulletin June 2009 93

ObituaryDr Sydney Dennis GiddyOAM 2008, FANZCA 1992, FFARACS 19681930 – 2009Dr Sydney Dennis Giddy had a majorrole in the development of anaesthesiain Ballarat and served the communityfor many years as president of SunwaysRetirement Home and as an active memberof the Rotary Club of Wendouree.Dr Giddy was born in Ilford, Essex in1930. He undertook his medical trainingin the UK, graduating from Birminghamin 1954. After completing his internshipand HMO year at Stoke-on-Trent and Bath,he spent two years with the Royal ArmyMedical Corp, and then returned to do hisobstetric training at Swindon. He obtainedhis D.Obst.RCOG in 1958 and workedin general practice in Wiltshire beforebecoming an anaesthetic registrar at theRoyal Victorian hospital at Swindon in 1960.Dr Giddy migrated to Australia in 1961coming to a general practice in Ballarat withan interest in anaesthesia and obstetricsand gynaecology. He was appointed assessional anaesthetist at Ballarat HealthServices and as an honorary anaesthetist atthe Royal Melbourne Hospital from 1966-68.With Dr Bill Dick, Dr Heather Lopert andDr Peter Theobald, formed the AnaestheticGroup, Ballarat. He continued his studyof anaesthesia while working full-timeat Ballarat Health Services and becameBallarat’s first formally trained specialistanaesthetist when he was awarded theFellowship of the Faculty of Anaesthetists,Royal Australasian College of Surgeonsin 1968.He established the Department ofAnaesthesia and set up the Intensive CareUnit. He was appointed as the first Directorof Anaesthesia at Ballarat Health Servicesin 1968. Syd was especially proud of thedevelopment of the ICU, as this was onlythe second intensive care unit to be setup in Victoria, a remarkable achievementdemonstrating enormous foresight.He set up a training program, withanaesthetic registrars from the RoyalMelbourne Hospital. Over the years hetrained many specialist anaesthetists,many who are now training younganaesthetists themselves. At least twelveof these trainees have returned to Ballaratto work as specialist anaesthetic VMO’sfor Ballarat Health Services.When he retired from the position ofdirector of the Department of Anaesthesiaand Intensive Care, he became a sessionalanaesthetist. Dr Giddy continued inprivate practice until he retired in 2004.He had established the department on avery sound footing, with registrars andhospital medical officers in training, alevel 2-3 intensive care unit supported by 12specialist anaesthetists/intensivists. It wasideally positioned for further development,a remarkable achievement for a smallregional hospital.Dr Giddy also worked tirelessly for thehospital medical officers as a whole. He waschairman of the Professional Staff Groupfrom 1974-1976, a very volatile time when wesaw the replacement of the honorary systemwith paid medical officers. He found timeto work on the medical advisory, medicalstandard and review, theatre and the librarycommittees within the hospital.He was a very active member of theAustralian Society of Anaesthetists, servingon the state committee from 1983-1995. Hewas Victorian chairman from 1989-90, andalso served on the federal committee.Dr Giddy was the senior local convenor ofthe 1988 Australian Society of Anaesthetists’National Scientific Conference in Ballarat.He was awarded the Gilbert Troupe Prize bythe society that year.In later years he undertook training ofanaesthetists in South East Asia as wellas in Victoria, single-handedly running acourse for second-part fellowship trainingin 1993.Dr Giddy held several otherappointments within the healthindustry. He was appointed to the HealthCommissionCommittee on AnaestheticMorbidity & Mortality in 1991 and servedas the ASA representative on the Councilof Hospital Standards.He was also on the Medical AdvisoryCommittee for the State AmbulanceService (1971).He helped set up a study to assessthe ability to theatre-train ambulancepersonnel for resuscitation at the roadside.It led to a continuing association withBallarat Ambulance Services in trainingambulance personnel in resuscitation,insertion of IV cannulas for fluid therapyand intubation. This study precededMICA training in Melbourne, anotherdemonstration of his foresight.Dr Giddy was involved with other sundrycommunity projects as well. He was anactive member of Rotary International(the Rotary Club of Wendouree, D9780) formany years, serving on many committees,and as the president.He had been on the council of SunwaysRetirement Home in Ballarat from 1979 untilthey were absorbed into the Uniting Churchprogram in 2007. He was the chairmanfrom 1979.Dr Giddy loved being fit, and continuedskiing at Falls Creek until last year.He was awarded the Medal of the Orderof Australia in 2008 for his services toanaesthesia and to the community. He wasvery pleased to provide a copy of the medalto the Anaesthetic Group, Ballarat for theirrole in his recognition. The anaestheticcommunity of Ballarat was very proud toreceive it.Dr Giddy was awarded EmeritusConsultant status by Ballarat HealthServices in 2005, and received a citationfrom the Post Graduate Foundation ofSt John of God Hospital in 2008, for hisdevelopment of anaesthesia in the BallaratHealth system.Dr Sydney Dennis Giddy was a sourceof inspiration to his trainees, to the peoplehe worked with and to the patients hehelped. He was devastated by the deathof his younger daughter Joy in 2006. Heis survived and sadly missed by his wifeof 55 years, Sybil, by his three survivingchildren, Martin, Pam and Peter, by his 10grandchildren and his many, many friends.Dr John OswaldDeputy Director of theDepartment of AnaesthesiaBallarat Health Services94The ANZCA Bulletin June 2009

FELLOWSHIP AFFAIRSProfessionaldocumentsFollowing the normal review processby Council, the following ProfessionalDocument has recently been approved:PS51 – Guidelines for the Safe Administrationof Injectable Drugs in AnaesthesiaAustralian and New Zealand Collegeof AnaesthetistsProfessional documentsP = ProfessionalT = TechnicalEX = ExaminationsPS = Professional standardsTE = Training and EducationalTE1 (2005) Recommendations for Hospitals Seeking College Approval for VocationalTraining in AnaesthesiaTE2 (2006) Policy on Vocational Training Modules and Module Supervision(interim review)TE3 (2006) Policy on Supervision of Clinical Experience for Vocational Traineesin AnaesthesiaTE4 (2003) Policy on Duties of Regional Education Officers in AnaesthesiaTE5 (2003) Policy for Supervisors of Training in AnaesthesiaTE6 (2006) Guidelines on the Duties of an AnaesthetistTE7 (2005) Guidelines for Secretarial and Support Services to Departmentsof AnaesthesiaTE8 (2003) Guidelines for the Learning Portfolio for Trainees in AnaesthesiaTE9 (2005) Guidelines on Quality Assurance in AnaesthesiaTE10 (2003) Recommendations for Vocational Training ProgramsTE11 (2008) Policy on the Formal Project (interim review)TE13 (2003) Guidelines for the Provisional Fellowship ProgramTE14 (2007) Policy for the In-Training Assessment of Trainees in AnaesthesiaTE17 (2003) Policy on Advisors of Candidates for Anaesthesia TrainingTE18 (2005) Guidelines for Assisting Trainees with DifficultiesEX1 (2006) Policy on Examination Candidates Suffering from Illness, Accidentor DisabilityT1 (2008) Recommendations on Minimum Facilities for Safe Administration ofAnaesthesia in Operating Suites and Other Anaesthetising Locations(interim review)T3 (2008) Minimum Safety Requirements for Anaesthetic Machines for Clinical PracticePS1 (2002) Recommendations on Essential Training for Rural General Practitioners inAustralia Proposing to Administer AnaesthesiaPS2 (2006) Statement on Credentialling and Defining the Scope of Clinical Practicein AnaesthesiaPS3 (2003) Guidelines for the Management of Major Regional AnalgesiaPS4 (2006) Recommendations for the Post-Anaesthesia Recovery RoomPS6 (2006) The Anaesthesia Record. Recommendations on the Recording of an Episodeof Anaesthesia CarePS7 (2008) Recommendations on the Pre-Anaesthesia ConsultationPS8 (2008) Guidelines on the Assistant for the AnaesthetistPS9 (2008) Guidelines on Sedation and/or Analgesia for Diagnostic and InterventionalMedical or Surgical ProceduresThe ANZCA Bulletin June 2009 95

FELLOWSHIP AFFAIRSProfessionaldocumentsContinuedPS10 (2004)PS12 (2007)PS15 (2006)PS16 (2008)PS18 (2008)PS19 (2006)PS20 (2006)PS21 (2003)PS26 (2005)PS27 (2004)PS28 (2005)PS29 (2008)PS31 (2003)PS37 (2004)PS38 (2004)PS39 (2003)PS40 (2005)PS41 (2007)PS42 (2006)PS43 (2007)PS44 (2006)PS45 (2008)PS46 (2004)PS47 (2008)PS49 (2008)PS50 (2004)PS51 (2009)Handover of Responsibility During an AnaestheticStatement on Smoking as Related to thePerioperative PeriodRecommendations for the Perioperative Care ofPatients Selected for Day Care SurgeryStatement on the Standards of Practice of aSpecialist AnaesthetistRecommendations on Monitoring During AnaesthesiaRecommendations on Monitored Care byan AnaesthetistRecommendations on Responsibilities of theAnaesthetist in the Post-Anaesthesia PeriodGuidelines on Conscious Sedation forDental ProceduresGuidelines on Consent for Anaesthesia or SedationGuidelines for Fellows who Practice MajorExtracorporeal PerfusionGuidelines on Infection Control in AnaesthesiaStatement on Anaesthesia Care of Children inHealthcare Facilities without Dedicated PaediatricFacilities (reissue)Recommendations on Checking AnaesthesiaDelivery SystemsRegional Anaesthesia and Allied HealthPractitionersStatement Relating to the Relief of Pain andSuffering and End of Life DecisionsMinimum Standards for Intrahospital Transport ofCritically Ill PatientsGuidelines for the Relationship Between Fellows andthe Healthcare IndustryGuidelines on Acute Pain ManagementRecommendations for Staffing of Departmentsof AnaesthesiaStatement on Fatigue and the AnaesthetistGuidelines to Fellows Acting on AppointmentsCommittees for Senior Staff in AnaesthesiaStatement on Patients’ Rights to Pain ManagementRecommendations for Training and Practiceof Diagnostic Perioperative TransoesophagealEchocardiography in AdultsGuidelines for Hospitals Seeking College Approvalof Posts for Vocational Training in Diving andHyperbaric MedicineGuidelines on the Health of Specialists and TraineesRecommendations on Practice Re-entry for aSpecialist AnaesthetistGuidelines for the Safe Administration of InjectableDrugs in AnaesthesiaAustralian and New Zealand Collegeof AnaesthetistsandJoint Faculty of Intensive CareMedicineProfessional documentsIC-1 (2003) Minimum Standards for Intensive Care UnitsIC-2 (2005) Intensive Care Specialist Practice in HospitalsAccredited for Training in Intensive Care MedicineIC-3 (2008) Guidelines for Intensive Care Units seekingAccreditation for Training in Intensive Care MedicineIC-4 (2006) The Supervision of Vocational Trainees inIntensive CareIC-6 (2002) The Role of Supervisors of Training in IntensiveCare Medicine MedicineIC-7 (2006) Administrative Services to Intensive Care UnitsIC-8 (2008) Quality AssuranceIC-9 (2002) Statement on the Ethical Practice of IntensiveCare MedicineIC-10 (2003) Minimum Standards for Transport of CriticallyIll PatientsIC-11 (2003) Guidelines for the In-Training Assessment ofTrainees in Intensive Care MedicineIC-12 (2001) Examination Candidates Suffering from Illness,Accident or DisabilityIC-13 (2008) Recommendations on Standards for HighDependency Units Seeking Accreditation forTraining in Intensive Care MedicineIC-14 (2004) Statement on Withholding and WithdrawingTreatmentIC-15 (2004) Recommendations of Practice Re-entry for anIntensive Care Specialist96The ANZCA Bulletin June 2009

Australian and New Zealand Collegeof AnaesthetistsandFaculty of Pain MedicineProfessional documentsPM2 (2005) Guidelines for Units Offering Training inMultidisciplinary Pain MedicinePM3 (2002) Lumbar Epidural Administration of CorticosteroidsPM4 (2005) Guidelines for Patient Assessment and Implantationof Intrathecal Catheters, Ports and Pumps forIntrathecal TherapyPM5 (2006) Policy for Supervisors of Training in Pain MedicinePM6 (2007) Guidelines for Longterm Intrathecal Infusions(Analgesics/Adjuvants/Antispasmodics)PS3 (2003) Guidelines for the Management of MajorRegional AnalgesiaPS38 (2004)PS39 (2003)PS40 (2005)PS41 (2007)PS45 (2008)PS49 (2008)Statement Relating to the Relief of Pain andSuffering and End of Life DecisionsMinimum Standards for Intrahospital Transport ofCritically Ill PatientsGuidelines for the Relationship Between Fellows andthe Healthcare IndustryGuidelines on Acute Pain ManagementStatement on Patients’ Rights to Pain Managementand Associated ResponsibilitiesGuidelines on the Health of Specialists and TraineesCollege Professional Documents adopted by the Faculty:PS4 (2006) Recommendations for the Post-AnaesthesiaRecovery Room (Adopted February 2001)PS7 (2008) Recommendations for the Pre-AnaesthesiaConsultation (Adopted November 2003)PS8 (2008) Guidelines on the Assistant for the Anaesthetist(Adopted November 2003)PS9 (2008) Guidelines on Sedation and/or Analgesia forDiagnostic and Interventional Medical or SurgicalProcedures (Adopted 2008)PS10 (2004)PS15 (2006)PS18 (2008)PS20 (2006)PS31 (2003)The Handover of Responsibility During anAnaesthetic (Adopted February 2001)Recommendations for the Perioperative Care ofPatients Selected for Day Care Surgery (AdoptedFebruary 2001)Recommendations on Monitoring DuringAnaesthesia (Adopted February 2001)Recommendations on Responsibilities of theAnaesthetist in the Post-Anaesthesia Period(Adopted February 2001)Recommendations on Checking AnaesthesiaDelivery Systems (Adopted July 2003)T1 (2008) Recommendations on Minimum Facilities for SafeAdministration of Anaesthesia in Operating Suitesand other Anaesthetising Locations (AdoptedMay 2006)The ANZCA Bulletin June 2009 97

Future meetingsAustralia& New Zealand2009July 3-6Melbourne, VIC8th International Congresson Ambulatory SurgeryTheme: The Destiny of Day SurgeryVenue: Brisbane Convention& Exhibition CentreContact: Conferences & EventsManagement, Royal AustralasianCollege of Surgeons, Collegeof Surgeons’ Gardens, Spring Street,Melbourne VIC 3000Tel: +61 3 9249 1273Fax: +61 3 9276 7431Email: iaas2009@surgeons.orgWebsite: www.iaascongress2009.orgJuly 18-19Brisbane, QLDOverseas Trained SpecialistAnaesthetists Network (Otsan) 11thEducational WeekendTheme: Upskilling of IMGS AnaesthetistsVenue: QLD College HeadquartersContact: Dr Kirstin WyssusekTel: +61 7 3636 7154Email: kerstin_wyssusek@health.qld.gov.auJuly 23-25Hunter Valley, NSWRural Specialist Interest GroupConferenceTheme: Gumnuts & Joeys - DeliveringAnaesthesia in the BushVenue: Crowne Plaza, Hunter Valley, NSWContact: Marta Dziedzicki, SIGsCoordinator ANZCATel: +61 3 9510 6299Fax: +61 3 9510 6786Email: mdziedzicki@anzca.edu.auJuly 24-25Melbourne, VIC2nd International Symposiumon Extra-corporeal Support inCritical CareTheme: ECMO and VADS in Intensive CareVenue: Park Hyatt Hotel, Melbourne, VICContact: Dr Vin PellegrinoTel: +61 3 9076 2612Fax: +61 3 9076 3780Email: v.pellegrino@alfred.org.auJuly 25Melbourne, VIC30th Annual Asa/anzca CombinedCme MeetingTheme: Anaesthesia Right Now!– A Clinical UpdateVenue: Sofitel Melbourne, VICContact: Daphne Erler – VRC CoordinatorTel: +61 3 9510 6299Fax: +61 3 9510 6786Email: vic@anzca.edu.auAugust 8Sydney, NSWNSW Anaesthetic ContinuingEducation MeetingVenue: Hilton Sydney HotelContact: Anna KouprianovaNSW Regional Events Co-ordinator117 Alexander Street, Crows Nest,NSW 2065Tel: +61 2 9966 9085Fax: +61 2 9966 9087Email: nswevents@anzca.edu.auAugust 22Brisbane, QLD33rd Annual Anzca/asa CombinedCme Committee Of QueenslandMeetingVenue: Queensland Turf ClubTheme: The Dabblers - OccasionalForays into Anaesthesia for Obstetrics,Paediatrics and TraumaContact: Linda Cuffe – EventCoordinator QRCTel: +61 7 3846 1233Fax: +61 7 3844 0249Email: qldevents@anzca.edu.auSeptember 5-8Darwin, NT68th National Scientific Congressof The Australian Society ofAnaesthetistsVenue: Darwin Convention CentreContact: SAPMEA Meetings ManagementTel: +61 8 8274 6048Fax: +61 8 8274 6000Email: asa2009@sapmea.ans.auWebsite: www.asa2009.comSeptember 7-11 Melbourne, VICSimtect Health 2009 SimulationConferenceTheme: Beyond Technical SkillsVenue: Hilton on the Park, MelbourneContact: Michaela AndelovaTel: +61 2 6251 0675Fax: +61 2 6251 0672Email: Michaela@consec.com.auWebsite: www.siaa.asn.auOctober 4-7Noosa, QLDCardiothoracic, Vascular andPerfusion Special Interest GroupConferenceVenue: Sheraton Noosa, QLDContact: Kate Briggs, SIGsCoordinator ANZCATel: +61 3 9510 6299Email: kbriggs@anzca.edu.auOctober 9-11Sydney, NSW2009 Combined Medical Education,Simulation, Welfare And ManagementSig MeetingTheme: What Makes an IdealAnaesthetist?Venue: The Byron at Byron,Byron Bay, NSWContact: Gay Hopgood, FellowshipAffairs Coordinator ANZCATel: +61 3 9510 6299Fax: +61 3 9510 6786Email: ghopgood@anzca.edu.au98 The ANZCA Bulletin June 2009

October 16-182009 Fpm Spring MeetingTheme: Duelling with PainVenue: Sofitel, MelbourneContact: Marta Dziedzicki, SIGSCoordinator ANZCATel: +61 3 9510 6299Fax: +61 3 9510 6786Email: painmed@anzca.edu.auMelbourne, VICOct 30 – Nov 1Canberra, ACTSpanza National Meeting 2009Theme: Ventilation of Neonates/Premsin the Operating Theatre/Update onPain Management/Ethical Mattersin Paediatric AnaesthesiaVenue: Hyatt Hotel CanberraContact: Stephen Brazenor– Regional ChairEmail: stbrazenor@dodo.com.auNovember 4-7Canberra, ACTNew Zealand Anaesthesia Asm 2009Theme: The Bottom LineVenue: Novotel Lakeside, Rotorua,New ZealandContact: Amanda GrahamTel: +64 7 843 1398Fax: +64 7 843 1397Email: nza@sixhats.co.nzWebsite: www.sixhats.co.nz/nza09November 14-15 Wollongong, VICNsw Anaesthetic ContinuingEducation MeetingVenue: Novotel Northbeach, WollongongContact: Anna KouprianovaNSW Regional Events Co-ordinator117 Alexander Street, Crows NestNSW 2065Tel: +61 2 9966 9085Fax: +61 2 9966 9087Email: akouprianova@anzca.edu.auNovember 20-232010March 28-31Brisbane, QLDAustralasian Symposium onUltrasound and Regional Anaesthesia(Asura) 2009Venue: Mater Mothers’ Hospital,Brisbane, QLDContact: Cassandra Hargreaves,ASA Events ManagerTel: +61 02 9327 4022Email: chargreaves@fed.asa.org.auWebsite: www.asura2009.anaesthesia.org.auGold Coast, QLDAustralian Pain Society/New ZealandPain Society Combined AnnualScientific MeetingTheme: The Impact of PainVenue: Gold Coast Convention CentreContact: DC ConferencesTel: +61 2 9954 4400Email: apsnzps@dcconferences.com.auWebsite: dcconferences.com.au/apsnzps/May 1-5Christchurch, NZANZCA 2010 ASMTheme: How meets Why: Clinical Practiceand the Science Behind itVenue: Christchurch, New ZealandContact: Rachel Cook, ConferenceInnovators, PO Box 13494, 196Gloucester Street, Christchurch 8011Tel: +64 3 379 0460Fax: +64 3 379 0460Email: rachel@conference.co.nzAugust 20-21Queenstown, NZAQUA Annual QueenstownUpdate in AnaesthesiaTheme: Anaesthesia UpdateVenue: Millennium Hotel QueenstownContact: Karen PatchingTel: +64 (0)9 3797440 ext 25700Email: karenp@adhb.govt.nzWebsite: www.aqua.ac.nzSeptember 2-5 Queenstown, NZSPANZA and Asian Society ofPaediatric Anaesthesiologists (APSA)Combined MeetingVenue: Millennium Hotel QueenstownContact: Peter KempthorneTel: +64 3 379039Fax: +64 3 379046Email: megan@conference.co.nzWebsite: www.spanza.org.auPlease check with conferenceorganisers for change in datesbefore arranging travel.The ANZCA Bulletin June 200999

2nd International Symposium onExtracorporeal Support in Critical CarePark Hyatt HotelMelbourne, Australia24th-25th July 2009Themes;Mechanical Circulatory SupportECMOAdvanced Mechanical VentilationProblems and Barriers to Extracorporeal SupportAnticoagulation management23rd July 2009Pre SymposiumECMO Cannulation WorkshopSee Website for DetailsKeynote SpeakersDr.Robert BartlettUMMC, USADr.Bart MeynsLeuven, BelgiumFor further information contact;Janine Dyer ( J.Dyer@alfred.org.au)Alfred Intensive CareL3 East Block,Commercial Rd,Melbourne Vic, 3004Visit our website at;http://www.ecmo.com.auemail: information@ecmo.com.au*GROUP DISCOUNTS APPLYTel: +613 9076 3036FAX:+613 9076 3780www.melbourne.park.hyatt.com

Christchurch 2010